1
|
Jeffrey K, Woolford L, Maini R, Basetti S, Batchelor A, Weatherill D, White C, Hammersley V, Millington T, Macdonald C, Quint JK, Kerr R, Kerr S, Shah SA, Rudan I, Fagbamigbe AF, Simpson CR, Katikireddi SV, Robertson C, Ritchie L, Sheikh A, Daines L. Prevalence and risk factors for long COVID among adults in Scotland using electronic health records: a national, retrospective, observational cohort study. EClinicalMedicine 2024; 71:102590. [PMID: 38623399 PMCID: PMC11016856 DOI: 10.1016/j.eclinm.2024.102590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 03/07/2024] [Accepted: 03/21/2024] [Indexed: 04/17/2024] Open
Abstract
Background Long COVID is a debilitating multisystem condition. The objective of this study was to estimate the prevalence of long COVID in the adult population of Scotland, and to identify risk factors associated with its development. Methods In this national, retrospective, observational cohort study, we analysed electronic health records (EHRs) for all adults (≥18 years) registered with a general medical practice and resident in Scotland between March 1, 2020, and October 26, 2022 (98-99% of the population). We linked data from primary care, secondary care, laboratory testing and prescribing. Four outcome measures were used to identify long COVID: clinical codes, free text in primary care records, free text on sick notes, and a novel operational definition. The operational definition was developed using Poisson regression to identify clinical encounters indicative of long COVID from a sample of negative and positive COVID-19 cases matched on time-varying propensity to test positive for SARS-CoV-2. Possible risk factors for long COVID were identified by stratifying descriptive statistics by long COVID status. Findings Of 4,676,390 participants, 81,219 (1.7%) were identified as having long COVID. Clinical codes identified the fewest cases (n = 1,092, 0.02%), followed by free text (n = 8,368, 0.2%), sick notes (n = 14,469, 0.3%), and the operational definition (n = 64,193, 1.4%). There was limited overlap in cases identified by the measures; however, temporal trends and patient characteristics were consistent across measures. Compared with the general population, a higher proportion of people with long COVID were female (65.1% versus 50.4%), aged 38-67 (63.7% versus 48.9%), overweight or obese (45.7% versus 29.4%), had one or more comorbidities (52.7% versus 36.0%), were immunosuppressed (6.9% versus 3.2%), shielding (7.9% versus 3.4%), or hospitalised within 28 days of testing positive (8.8% versus 3.3%%), and had tested positive before Omicron became the dominant variant (44.9% versus 35.9%). The operational definition identified long COVID cases with combinations of clinical encounters (from four symptoms, six investigation types, and seven management strategies) recorded in EHRs within 4-26 weeks of a positive SARS-CoV-2 test. These combinations were significantly (p < 0.0001) more prevalent in positive COVID-19 patients than in matched negative controls. In a case-crossover analysis, 16.4% of those identified by the operational definition had similar healthcare patterns recorded before testing positive. Interpretation The prevalence of long COVID presenting in general practice was estimated to be 0.02-1.7%, depending on the measure used. Due to challenges in diagnosing long COVID and inconsistent recording of information in EHRs, the true prevalence of long COVID is likely to be higher. The operational definition provided a novel approach but relied on a restricted set of symptoms and may misclassify individuals with pre-existing health conditions. Further research is needed to refine and validate this approach. Funding Chief Scientist Office (Scotland), Medical Research Council, and BREATHE.
Collapse
Affiliation(s)
- Karen Jeffrey
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Lana Woolford
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Rishma Maini
- Public Health Scotland, Glasgow and Edinburgh, UK
| | | | - Ashleigh Batchelor
- Patient and Public Contributors, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - David Weatherill
- Patient and Public Contributors, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Chris White
- Patient and Public Contributors, Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | | | | | - Jennifer K. Quint
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Robin Kerr
- NHS Borders, Melrose, UK
- NHS Dumfries & Galloway, Dumfries, UK
| | - Steven Kerr
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | - Igor Rudan
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | - Colin R. Simpson
- Usher Institute, University of Edinburgh, Edinburgh, UK
- School of Health, Wellington Faculty of Health, Victoria University of Wellington, Wellington, NZ
| | - Srinivasa Vittal Katikireddi
- Public Health Scotland, Glasgow and Edinburgh, UK
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Chris Robertson
- Public Health Scotland, Glasgow and Edinburgh, UK
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - Lewis Ritchie
- Academic Primary Care, University of Aberdeen, Aberdeen, UK
- Institute of Applied Health Sciences, University of Aberdeen, UK
| | - Aziz Sheikh
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Luke Daines
- Usher Institute, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
2
|
Shi T, Millington T, Robertson C, Jeffrey K, Katikireddi SV, McCowan C, Simpson CR, Woolford L, Daines L, Kerr S, Swallow B, Fagbamigbe A, Vallejos CA, Weatherill D, Jayacodi S, Marsh K, McMenamin J, Rudan I, Ritchie LD, Mueller T, Kurdi A, Sheikh A. Risk of winter hospitalisation and death from acute respiratory infections in Scotland: national retrospective cohort study. J R Soc Med 2024:1410768231223584. [PMID: 38345538 DOI: 10.1177/01410768231223584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024] Open
Abstract
OBJECTIVES We undertook a national analysis to characterise and identify risk factors for acute respiratory infections (ARIs) resulting in hospitalisation during the winter period in Scotland. DESIGN A population-based retrospective cohort analysis. SETTING Scotland. PARTICIPANTS The study involved 5.4 million residents in Scotland. MAIN OUTCOME MEASURES Cox proportional hazard models were used to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for the association between risk factors and ARI hospitalisation. RESULTS Between 1 September 2022 and 31 January 2023, there were 22,284 (10.9% of 203,549 with any emergency hospitalisation) ARI hospitalisations (1759 in children and 20,525 in adults) in Scotland. Compared with the reference group of children aged 6-17 years, the risk of ARI hospitalisation was higher in children aged 3-5 years (aHR = 4.55; 95% CI: 4.11-5.04). Compared with those aged 25-29 years, the risk of ARI hospitalisation was highest among the oldest adults aged ≥80 years (aHR = 7.86; 95% CI: 7.06-8.76). Adults from more deprived areas (most deprived vs. least deprived, aHR = 1.64; 95% CI: 1.57-1.72), with existing health conditions (≥5 vs. 0 health conditions, aHR = 4.84; 95% CI: 4.53-5.18) or with history of all-cause emergency admissions (≥6 vs. 0 previous emergency admissions, aHR = 7.53; 95% CI: 5.48-10.35) were at a higher risk of ARI hospitalisations. The risk increased by the number of existing health conditions and previous emergency admission. Similar associations were seen in children. CONCLUSIONS Younger children, older adults, those from more deprived backgrounds and individuals with greater numbers of pre-existing conditions and previous emergency admission were at increased risk for winter hospitalisations for ARI.
Collapse
Affiliation(s)
- Ting Shi
- Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, EH8 9AG, Scotland, UK
| | - Tristan Millington
- Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, EH8 9AG, Scotland, UK
| | - Chris Robertson
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, G1 1XQ, Scotland, UK
- Public Health Scotland, Glasgow, G2 6QE, Scotland, UK
| | - Karen Jeffrey
- Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, EH8 9AG, Scotland, UK
| | | | - Colin McCowan
- School of Medicine, University of St Andrews, St Andrews, KY16 9AJ, Scotland, UK
| | - Colin R Simpson
- Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, EH8 9AG, Scotland, UK
- School of Health, Wellington Faculty of Health, Victoria University of Wellington, Wellington, 6140, New Zealand
| | - Lana Woolford
- Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, EH8 9AG, Scotland, UK
| | - Luke Daines
- Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, EH8 9AG, Scotland, UK
- Asthma UK Centre for Applied Research, Usher Institute, University of Edinburgh, Edinburgh, EH8 9AG, Scotland, UK
| | - Steven Kerr
- Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, EH8 9AG, Scotland, UK
| | - Ben Swallow
- School of Mathematics and Statistics, University of St Andrews, St Andrews, KY16 9SS, Scotland, UK
| | - Adeniyi Fagbamigbe
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, AB24 2ZD, Scotland, UK
- Department of Epidemiology and Medical Statistics, University of Ibadan, Ibadan 200132, Nigeria
| | - Catalina A Vallejos
- MRC Human Genetics Unit, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, EH4 2XU, Scotland, UK
- The Alan Turing Institute, London, NW1 2DB, UK
| | - David Weatherill
- Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, EH8 9AG, Scotland, UK
| | - Sandra Jayacodi
- Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, EH8 9AG, Scotland, UK
| | | | - Jim McMenamin
- Public Health Scotland, Glasgow, G2 6QE, Scotland, UK
| | - Igor Rudan
- Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, EH8 9AG, Scotland, UK
| | - Lewis Duthie Ritchie
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, AB24 2ZD, Scotland, UK
| | - Tanja Mueller
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, G4 0RE, Scotland, UK
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, G4 0RE, Scotland, UK
- Department of Clinical Pharmacy, College of Pharmacy, Hawler Medical University, Erbil, Iraq
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, 0208, South Africa
- Department of Clinical Pharmacy, College of Pharmacy, Al-Kitab University, Kirkuk, Iraq
| | - Aziz Sheikh
- Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, EH8 9AG, Scotland, UK
- Asthma UK Centre for Applied Research, Usher Institute, University of Edinburgh, Edinburgh, EH8 9AG, Scotland, UK
| |
Collapse
|
3
|
Kerr S, Bedston S, Cezard G, Sampri A, Murphy S, Bradley DT, Morrison K, Akbari A, Whiteley W, Sullivan C, Patterson L, Khunti K, Denaxas S, Bolton T, Khan S, Keys A, Weatherill D, Mooney K, Davies J, Ritchie L, McMenamin J, Kee F, Wood A, Lyons RA, Sudlow C, Robertson C, Sheikh A. Undervaccination and severe COVID-19 outcomes: meta-analysis of national cohort studies in England, Northern Ireland, Scotland, and Wales. Lancet 2024; 403:554-566. [PMID: 38237625 DOI: 10.1016/s0140-6736(23)02467-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 10/31/2023] [Accepted: 11/02/2023] [Indexed: 02/12/2024]
Abstract
BACKGROUND Undervaccination (receiving fewer than the recommended number of SARS-CoV-2 vaccine doses) could be associated with increased risk of severe COVID-19 outcomes-ie, COVID-19 hospitalisation or death-compared with full vaccination (receiving the recommended number of SARS-CoV-2 vaccine doses). We sought to determine the factors associated with undervaccination, and to investigate the risk of severe COVID-19 outcomes in people who were undervaccinated in each UK nation and across the UK. METHODS We used anonymised, harmonised electronic health record data with whole population coverage to carry out cohort studies in England, Northern Ireland, Scotland, and Wales. Participants were required to be at least 5 years of age to be included in the cohorts. We estimated adjusted odds ratios for undervaccination as of June 1, 2022. We also estimated adjusted hazard ratios (aHRs) for severe COVID-19 outcomes during the period June 1 to Sept 30, 2022, with undervaccination as a time-dependent exposure. We combined results from nation-specific analyses in a UK-wide fixed-effect meta-analysis. We estimated the reduction in severe COVID-19 outcomes associated with a counterfactual scenario in which everyone in the UK was fully vaccinated on June 1, 2022. FINDINGS The numbers of people undervaccinated on June 1, 2022 were 26 985 570 (45·8%) of 58 967 360 in England, 938 420 (49·8%) of 1 885 670 in Northern Ireland, 1 709 786 (34·2%) of 4 992 498 in Scotland, and 773 850 (32·8%) of 2 358 740 in Wales. People who were younger, from more deprived backgrounds, of non-White ethnicity, or had a lower number of comorbidities were less likely to be fully vaccinated. There was a total of 40 393 severe COVID-19 outcomes in the cohorts, with 14 156 of these in undervaccinated participants. We estimated the reduction in severe COVID-19 outcomes in the UK over 4 months of follow-up associated with a counterfactual scenario in which everyone was fully vaccinated on June 1, 2022 as 210 (95% CI 94-326) in the 5-15 years age group, 1544 (1399-1689) in those aged 16-74 years, and 5426 (5340-5512) in those aged 75 years or older. aHRs for severe COVID-19 outcomes in the meta-analysis for the age group of 75 years or older were 2·70 (2·61-2·78) for one dose fewer than recommended, 3·13 (2·93-3·34) for two fewer, 3·61 (3·13-4·17) for three fewer, and 3·08 (2·89-3·29) for four fewer. INTERPRETATION Rates of undervaccination against COVID-19 ranged from 32·8% to 49·8% across the four UK nations in summer, 2022. Undervaccination was associated with an elevated risk of severe COVID-19 outcomes. FUNDING UK Research and Innovation National Core Studies: Data and Connectivity.
Collapse
|
4
|
Millington T, Morrison K, Jeffrey K, Sullivan C, Kurdi A, Fagbamigbe AF, Swallow B, Shi T, Shah SA, Kerr S, Simpson CR, Ritchie LD, Robertson C, Sheikh A, Rudan I. Caveats in reporting of national vaccine uptake. J Glob Health 2024; 14:03006. [PMID: 38330197 PMCID: PMC10852533 DOI: 10.7189/jogh.14.03006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024] Open
Affiliation(s)
| | | | - Karen Jeffrey
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | | | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- Department of Clinical Pharmacy, College of Pharmacy, Hawler Medical University, Erbil, Iraq
- College of Pharmacy, Al-Kitab University, Kirkuk, Iraq
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | | | - Ben Swallow
- School of Mathematics and Statistics, University of St Andrews, UK
| | - Ting Shi
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | | | - Steven Kerr
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Colin R Simpson
- Usher Institute, The University of Edinburgh, Edinburgh, UK
- School of Health, Wellington Faculty of Health, Victoria University of Wellington, Wellington, NZ
| | - Lewis D Ritchie
- School of Medicine, Medical Sciences & Nutrition, Academic Primary Care, University of Aberdeen, UK
| | - Chris Robertson
- Public Health Scotland, Glasgow, UK
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - Aziz Sheikh
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Igor Rudan
- Usher Institute, The University of Edinburgh, Edinburgh, UK
- Algebra University College, Zagreb, Croatia
| |
Collapse
|
5
|
Morgado BE, Sicardy B, Braga-Ribas F, Ortiz JL, Salo H, Vachier F, Desmars J, Pereira CL, Santos-Sanz P, Sfair R, de Santana T, Assafin M, Vieira-Martins R, Gomes-Júnior AR, Margoti G, Dhillon VS, Fernández-Valenzuela E, Broughton J, Bradshaw J, Langersek R, Benedetti-Rossi G, Souami D, Holler BJ, Kretlow M, Boufleur RC, Camargo JIB, Duffard R, Beisker W, Morales N, Lecacheux J, Rommel FL, Herald D, Benz W, Jehin E, Jankowsky F, Marsh TR, Littlefair SP, Bruno G, Pagano I, Brandeker A, Collier-Cameron A, Florén HG, Hara N, Olofsson G, Wilson TG, Benkhaldoun Z, Busuttil R, Burdanov A, Ferrais M, Gault D, Gillon M, Hanna W, Kerr S, Kolb U, Nosworthy P, Sebastian D, Snodgrass C, Teng JP, de Wit J. Author Correction: A dense ring of the trans-Neptunian object Quaoar outside its Roche limit. Nature 2024; 626:E2. [PMID: 38228877 DOI: 10.1038/s41586-024-07031-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Affiliation(s)
- B E Morgado
- Federal University of Rio de Janeiro - Observatory of Valongo, Rio de Janeiro, Brazil.
- National Observatory/MCTI, Rio de Janeiro, Brazil.
- Interinstitutional e-Astronomy Laboratory (LIneA), Rio de Janeiro, Brazil.
| | - B Sicardy
- LESIA, Observatory of Paris, University PSL, CNRS, UPMC, Sorbonne University, University of Paris Diderot, Sorbonne Paris City, Meudon, France
| | - F Braga-Ribas
- Federal University of Technology, Paraná (UTFPR/DAFIS), Curitiba, Brazil
| | - J L Ortiz
- Institute of Astrophysics at Andalucía, IAA-CSIC, Granada, Spain
| | - H Salo
- Space Physics and Astronomy Research unit, University of Oulu, Oulu, Finland
| | - F Vachier
- The Institute of Celestial Mechanics and Ephemeris Calculation (IMCCE), Observatory of Paris, PSL Research University, CNRS, Sorbonne University, UPMC University of Paris, University of Lille, Lille, France
| | - J Desmars
- The Institute of Celestial Mechanics and Ephemeris Calculation (IMCCE), Observatory of Paris, PSL Research University, CNRS, Sorbonne University, UPMC University of Paris, University of Lille, Lille, France
- Polytechnic Institute of Advanced Sciences (IPSA), Ivry-sur-Seine, France
| | - C L Pereira
- National Observatory/MCTI, Rio de Janeiro, Brazil
- Interinstitutional e-Astronomy Laboratory (LIneA), Rio de Janeiro, Brazil
| | - P Santos-Sanz
- Institute of Astrophysics at Andalucía, IAA-CSIC, Granada, Spain
| | - R Sfair
- Institute for Astronomy and Astrophysics, Eberhard Karls University of Tübingen, Tübingen, Germany
- Orbital Dynamics and Planetology Group, UNESP - São Paulo State University, Guaratinguetá, Brazil
| | - T de Santana
- LESIA, Observatory of Paris, University PSL, CNRS, UPMC, Sorbonne University, University of Paris Diderot, Sorbonne Paris City, Meudon, France
- Orbital Dynamics and Planetology Group, UNESP - São Paulo State University, Guaratinguetá, Brazil
| | - M Assafin
- Federal University of Rio de Janeiro - Observatory of Valongo, Rio de Janeiro, Brazil
- Interinstitutional e-Astronomy Laboratory (LIneA), Rio de Janeiro, Brazil
| | - R Vieira-Martins
- National Observatory/MCTI, Rio de Janeiro, Brazil
- Interinstitutional e-Astronomy Laboratory (LIneA), Rio de Janeiro, Brazil
| | - A R Gomes-Júnior
- Interinstitutional e-Astronomy Laboratory (LIneA), Rio de Janeiro, Brazil
- Orbital Dynamics and Planetology Group, UNESP - São Paulo State University, Guaratinguetá, Brazil
- Institute of Physics, Federal University of Uberlândia, Uberlândia, Brazil
| | - G Margoti
- Federal University of Technology, Paraná (UTFPR/DAFIS), Curitiba, Brazil
| | - V S Dhillon
- Department of Physics and Astronomy, University of Sheffield, Sheffield, UK
- Institute of Astrophysics of The Canary Islands, La Laguna, Spain
| | | | - J Broughton
- Reedy Creek Observatory, Gold Coast, Queensland, Australia
- Trans-Tasman Occultation Alliance (TTOA), Wellington, New Zealand
| | - J Bradshaw
- Samford Valley Observatory (Q79), Brisbane, Queensland, Australia
| | - R Langersek
- Algester Astronomical Observatory, Brisbane, Queensland, Australia
| | - G Benedetti-Rossi
- Interinstitutional e-Astronomy Laboratory (LIneA), Rio de Janeiro, Brazil
- Orbital Dynamics and Planetology Group, UNESP - São Paulo State University, Guaratinguetá, Brazil
| | - D Souami
- LESIA, Observatory of Paris, University PSL, CNRS, UPMC, Sorbonne University, University of Paris Diderot, Sorbonne Paris City, Meudon, France
- Observatory of the Côte d'Azur, Lagrange Laboratory UMR7293 CNRS, Nice, France
- naXys, University of Namur, Namur, Belgium
| | - B J Holler
- Space Telescope Science Institute, Baltimore, MD, USA
| | - M Kretlow
- Institute of Astrophysics at Andalucía, IAA-CSIC, Granada, Spain
- International Occultation Timing Association / European Section, Hannover, Germany
- International Amateur Observatory e.V. (IAS), Mittenwalde, Germany
| | - R C Boufleur
- National Observatory/MCTI, Rio de Janeiro, Brazil
- Interinstitutional e-Astronomy Laboratory (LIneA), Rio de Janeiro, Brazil
| | - J I B Camargo
- National Observatory/MCTI, Rio de Janeiro, Brazil
- Interinstitutional e-Astronomy Laboratory (LIneA), Rio de Janeiro, Brazil
| | - R Duffard
- Institute of Astrophysics at Andalucía, IAA-CSIC, Granada, Spain
| | - W Beisker
- International Occultation Timing Association / European Section, Hannover, Germany
- International Amateur Observatory e.V. (IAS), Mittenwalde, Germany
| | - N Morales
- Institute of Astrophysics at Andalucía, IAA-CSIC, Granada, Spain
| | - J Lecacheux
- LESIA, Observatory of Paris, University PSL, CNRS, UPMC, Sorbonne University, University of Paris Diderot, Sorbonne Paris City, Meudon, France
| | - F L Rommel
- National Observatory/MCTI, Rio de Janeiro, Brazil
- Interinstitutional e-Astronomy Laboratory (LIneA), Rio de Janeiro, Brazil
| | - D Herald
- Trans-Tasman Occultation Alliance (TTOA), Wellington, New Zealand
| | - W Benz
- Institute of Physics, University of Bern, Bern, Switzerland
- Center for Space and Habitability, University of Bern, Bern, Switzerland
| | - E Jehin
- STAR Institute, University of Liège, Liège, Belgium
| | - F Jankowsky
- Heidelberg-Königstuhl State Observatory, Heidelberg, Germany
| | - T R Marsh
- Department of Physics, University of Warwick, Coventry, UK
| | - S P Littlefair
- Department of Physics and Astronomy, University of Sheffield, Sheffield, UK
| | - G Bruno
- INAF, Catania Astrophysical Observatory, Catania, Italy
| | - I Pagano
- INAF, Catania Astrophysical Observatory, Catania, Italy
| | - A Brandeker
- Department of Astronomy, Stockholm University, AlbaNova University Center, Stockholm, Sweden
| | - A Collier-Cameron
- Centre for Exoplanet Science, SUPA School of Physics and Astronomy, University of St Andrews, North Haugh, St Andrews, UK
| | - H G Florén
- Department of Astronomy, Stockholm University, AlbaNova University Center, Stockholm, Sweden
| | - N Hara
- Astronomical Observatory at the University of Geneva, Versoix, Switzerland
| | - G Olofsson
- Department of Astronomy, Stockholm University, AlbaNova University Center, Stockholm, Sweden
| | - T G Wilson
- Centre for Exoplanet Science, SUPA School of Physics and Astronomy, University of St Andrews, North Haugh, St Andrews, UK
| | - Z Benkhaldoun
- Oukaimeden Observatory, High Energy Physics and Astrophysics Laboratory, FSSM, Cadi Ayyad University, Marrakech, Morocco
| | - R Busuttil
- School of Physical Sciences, The Open University, Walton Hall, Milton Keynes, UK
| | - A Burdanov
- Department of Earth, Atmospheric and Planetary Sciences, MIT, Cambridge, MA, USA
| | - M Ferrais
- Laboratory of Astrophysics of Marseille, University of Aix Marseille, CNRS, CNES, Marseille, France
| | - D Gault
- Trans-Tasman Occultation Alliance (TTOA), Wellington, New Zealand
| | - M Gillon
- Astrobiology Research Unit, University of Liège, Liège, Belgium
| | - W Hanna
- Trans-Tasman Occultation Alliance (TTOA), Wellington, New Zealand
| | - S Kerr
- Trans-Tasman Occultation Alliance (TTOA), Wellington, New Zealand
- Astronomical Association of Queensland, Pimpama, Queensland, Australia
| | - U Kolb
- School of Physical Sciences, The Open University, Walton Hall, Milton Keynes, UK
| | - P Nosworthy
- Trans-Tasman Occultation Alliance (TTOA), Wellington, New Zealand
| | - D Sebastian
- School of Physics and Astronomy, University of Birmingham, Birmingham, UK
| | - C Snodgrass
- Institute for Astronomy, University of Edinburgh, Royal Observatory, Edinburgh, UK
| | - J P Teng
- AGORA Observatory of Makes, AGORA, La Rivière, France
| | - J de Wit
- Department of Earth, Atmospheric and Planetary Sciences, MIT, Cambridge, MA, USA
| |
Collapse
|
6
|
Kerr S, Millington T, Rudan I, McCowan C, Tibble H, Jeffrey K, Fagbamigbe AF, Simpson CR, Robertson C, Hippisley-Cox J, Sheikh A. External validation of the QCovid 2 and 3 risk prediction algorithms for risk of COVID-19 hospitalisation and mortality in adults: a national cohort study in Scotland. BMJ Open 2023; 13:e075958. [PMID: 38151278 PMCID: PMC10753764 DOI: 10.1136/bmjopen-2023-075958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 10/20/2023] [Indexed: 12/29/2023] Open
Abstract
OBJECTIVE The QCovid 2 and 3 algorithms are risk prediction tools developed during the second wave of the COVID-19 pandemic that can be used to predict the risk of COVID-19 hospitalisation and mortality, taking vaccination status into account. In this study, we assess their performance in Scotland. METHODS We used the Early Pandemic Evaluation and Enhanced Surveillance of COVID-19 national data platform consisting of individual-level data for the population of Scotland (5.4 million residents). Primary care data were linked to reverse-transcription PCR virology testing, hospitalisation and mortality data. We assessed the discrimination and calibration of the QCovid 2 and 3 algorithms in predicting COVID-19 hospitalisations and deaths between 8 December 2020 and 15 June 2021. RESULTS Our validation dataset comprised 465 058 individuals, aged 19-100. We found the following performance metrics (95% CIs) for QCovid 2 and 3: Harrell's C 0.84 (0.82 to 0.86) for hospitalisation, and 0.92 (0.90 to 0.94) for death, observed-expected ratio of 0.24 for hospitalisation and 0.26 for death (ie, both the number of hospitalisations and the number of deaths were overestimated), and a Brier score of 0.0009 (0.00084 to 0.00096) for hospitalisation and 0.00036 (0.00032 to 0.0004) for death. CONCLUSIONS We found good discrimination of the QCovid 2 and 3 algorithms in Scotland, although performance was worse in higher age groups. Both the number of hospitalisations and the number of deaths were overestimated.
Collapse
Affiliation(s)
- Steven Kerr
- Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Tristan Millington
- Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Igor Rudan
- Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Colin McCowan
- School of Medicine, University of St. Andrews, St Andrews, UK
| | - Holly Tibble
- Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Karen Jeffrey
- Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Adeniyi Francis Fagbamigbe
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
- Department of Epidemiology and Medical Statistics, University of Ibadan, Ibadan, Nigeria
| | - Colin R Simpson
- Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Chris Robertson
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - Julia Hippisley-Cox
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Aziz Sheikh
- Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| |
Collapse
|
7
|
Swets MC, Kerr S, Scott-Brown J, Brown AB, Gupta R, Millar JE, Spata E, McCurrach F, Bretherick AD, Docherty A, Harrison D, Rowan K, Young N, Groeneveld GH, Dunning J, Nguyen-Van-Tam JS, Openshaw P, Horby PW, Harrison E, Staplin N, Semple MG, Lone N, Baillie JK. Evaluation of pragmatic oxygenation measurement as a proxy for Covid-19 severity. Nat Commun 2023; 14:7374. [PMID: 37968269 PMCID: PMC10651917 DOI: 10.1038/s41467-023-42205-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 10/04/2023] [Indexed: 11/17/2023] Open
Abstract
Choosing optimal outcome measures maximizes statistical power, accelerates discovery and improves reliability in early-phase trials. We devised and evaluated a modification to a pragmatic measure of oxygenation function, the [Formula: see text] ratio. Because of the ceiling effect in oxyhaemoglobin saturation, [Formula: see text] ratio ceases to reflect pulmonary oxygenation function at high [Formula: see text] values. We found that the correlation of [Formula: see text] with the reference standard ([Formula: see text]/[Formula: see text] ratio) improves substantially when excluding [Formula: see text] and refer to this measure as [Formula: see text]. Using observational data from 39,765 hospitalised COVID-19 patients, we demonstrate that [Formula: see text] is predictive of mortality, and compare the sample sizes required for trials using four different outcome measures. We show that a significant difference in outcome could be detected with the smallest sample size using [Formula: see text]. We demonstrate that [Formula: see text] is an effective intermediate outcome measure in COVID-19. It is a non-invasive measurement, representative of disease severity and provides greater statistical power.
Collapse
Affiliation(s)
- Maaike C Swets
- Roslin Institute, University of Edinburgh, Edinburgh, UK
- Department of Infectious Diseases, Leiden University Medical Center, Leiden University, Leiden, The Netherlands
| | - Steven Kerr
- Roslin Institute, University of Edinburgh, Edinburgh, UK
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | - Adam B Brown
- Roslin Institute, University of Edinburgh, Edinburgh, UK
| | - Rishi Gupta
- Institute for Global Health, University College London, London, UK
| | | | - Enti Spata
- Medical Research Council Population Health Research Unit at the University of Oxford, Nuffield Department of Population Health (NDPH), Oxford, UK
| | - Fiona McCurrach
- EMERGE, NHS Lothian, Royal Infirmary Edinburgh, Edinburgh, UK
| | - Andrew D Bretherick
- MRC Human Genetics Unit, Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital, Edinburgh, UK
| | - Annemarie Docherty
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - David Harrison
- Intensive Care National Audit & Research Centre, London, UK
| | - Kathy Rowan
- Intensive Care National Audit & Research Centre, London, UK
| | - Neil Young
- Department of Anaesthesia, Critical Care and Pain Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Geert H Groeneveld
- Department of Infectious Diseases, Leiden University Medical Center, Leiden University, Leiden, The Netherlands
| | - Jake Dunning
- Pandemic Sciences Institute, University of Oxford, Oxford, UK
| | | | - Peter Openshaw
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Peter W Horby
- Pandemic Sciences Institute, University of Oxford, Oxford, UK
| | - Ewen Harrison
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Natalie Staplin
- Medical Research Council Population Health Research Unit at the University of Oxford, Nuffield Department of Population Health (NDPH), Oxford, UK
| | - Malcolm G Semple
- Institute of Infection, Veterinary and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
- Department of Respiratory Medicine, Alder Hey Children's Hospital, Liverpool, UK
| | - Nazir Lone
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
- Intensive Care Unit, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, UK
| | - J Kenneth Baillie
- Roslin Institute, University of Edinburgh, Edinburgh, UK.
- Intensive Care Unit, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, UK.
- Baillie Gifford Pandemic Science Hub, Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK.
- MRC Human Genetics Unit, Institute for Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK.
| |
Collapse
|
8
|
Raman B, McCracken C, Cassar MP, Moss AJ, Finnigan L, Samat AHA, Ogbole G, Tunnicliffe EM, Alfaro-Almagro F, Menke R, Xie C, Gleeson F, Lukaschuk E, Lamlum H, McGlynn K, Popescu IA, Sanders ZB, Saunders LC, Piechnik SK, Ferreira VM, Nikolaidou C, Rahman NM, Ho LP, Harris VC, Shikotra A, Singapuri A, Pfeffer P, Manisty C, Kon OM, Beggs M, O'Regan DP, Fuld J, Weir-McCall JR, Parekh D, Steeds R, Poinasamy K, Cuthbertson DJ, Kemp GJ, Semple MG, Horsley A, Miller CA, O'Brien C, Shah AM, Chiribiri A, Leavy OC, Richardson M, Elneima O, McAuley HJC, Sereno M, Saunders RM, Houchen-Wolloff L, Greening NJ, Bolton CE, Brown JS, Choudhury G, Diar Bakerly N, Easom N, Echevarria C, Marks M, Hurst JR, Jones MG, Wootton DG, Chalder T, Davies MJ, De Soyza A, Geddes JR, Greenhalf W, Howard LS, Jacob J, Man WDC, Openshaw PJM, Porter JC, Rowland MJ, Scott JT, Singh SJ, Thomas DC, Toshner M, Lewis KE, Heaney LG, Harrison EM, Kerr S, Docherty AB, Lone NI, Quint J, Sheikh A, Zheng B, Jenkins RG, Cox E, Francis S, Halling-Brown M, Chalmers JD, Greenwood JP, Plein S, Hughes PJC, Thompson AAR, Rowland-Jones SL, Wild JM, Kelly M, Treibel TA, Bandula S, Aul R, Miller K, Jezzard P, Smith S, Nichols TE, McCann GP, Evans RA, Wain LV, Brightling CE, Neubauer S, Baillie JK, Shaw A, Hairsine B, Kurasz C, Henson H, Armstrong L, Shenton L, Dobson H, Dell A, Lucey A, Price A, Storrie A, Pennington C, Price C, Mallison G, Willis G, Nassa H, Haworth J, Hoare M, Hawkings N, Fairbairn S, Young S, Walker S, Jarrold I, Sanderson A, David C, Chong-James K, Zongo O, James WY, Martineau A, King B, Armour C, McAulay D, Major E, McGinness J, McGarvey L, Magee N, Stone R, Drain S, Craig T, Bolger A, Haggar A, Lloyd A, Subbe C, Menzies D, Southern D, McIvor E, Roberts K, Manley R, Whitehead V, Saxon W, Bularga A, Mills NL, El-Taweel H, Dawson J, Robinson L, Saralaya D, Regan K, Storton K, Brear L, Amoils S, Bermperi A, Elmer A, Ribeiro C, Cruz I, Taylor J, Worsley J, Dempsey K, Watson L, Jose S, Marciniak S, Parkes M, McQueen A, Oliver C, Williams J, Paradowski K, Broad L, Knibbs L, Haynes M, Sabit R, Milligan L, Sampson C, Hancock A, Evenden C, Lynch C, Hancock K, Roche L, Rees M, Stroud N, Thomas-Woods T, Heller S, Robertson E, Young B, Wassall H, Babores M, Holland M, Keenan N, Shashaa S, Price C, Beranova E, Ramos H, Weston H, Deery J, Austin L, Solly R, Turney S, Cosier T, Hazelton T, Ralser M, Wilson A, Pearce L, Pugmire S, Stoker W, McCormick W, Dewar A, Arbane G, Kaltsakas G, Kerslake H, Rossdale J, Bisnauthsing K, Aguilar Jimenez LA, Martinez LM, Ostermann M, Magtoto MM, Hart N, Marino P, Betts S, Solano TS, Arias AM, Prabhu A, Reed A, Wrey Brown C, Griffin D, Bevan E, Martin J, Owen J, Alvarez Corral M, Williams N, Payne S, Storrar W, Layton A, Lawson C, Mills C, Featherstone J, Stephenson L, Burdett T, Ellis Y, Richards A, Wright C, Sykes DL, Brindle K, Drury K, Holdsworth L, Crooks MG, Atkin P, Flockton R, Thackray-Nocera S, Mohamed A, Taylor A, Perkins E, Ross G, McGuinness H, Tench H, Phipps J, Loosley R, Wolf-Roberts R, Coetzee S, Omar Z, Ross A, Card B, Carr C, King C, Wood C, Copeland D, Calvelo E, Chilvers ER, Russell E, Gordon H, Nunag JL, Schronce J, March K, Samuel K, Burden L, Evison L, McLeavey L, Orriss-Dib L, Tarusan L, Mariveles M, Roy M, Mohamed N, Simpson N, Yasmin N, Cullinan P, Daly P, Haq S, Moriera S, Fayzan T, Munawar U, Nwanguma U, Lingford-Hughes A, Altmann D, Johnston D, Mitchell J, Valabhji J, Price L, Molyneaux PL, Thwaites RS, Walsh S, Frankel A, Lightstone L, Wilkins M, Willicombe M, McAdoo S, Touyz R, Guerdette AM, Warwick K, Hewitt M, Reddy R, White S, McMahon A, Hoare A, Knighton A, Ramos A, Te A, Jolley CJ, Speranza F, Assefa-Kebede H, Peralta I, Breeze J, Shevket K, Powell N, Adeyemi O, Dulawan P, Adrego R, Byrne S, Patale S, Hayday A, Malim M, Pariante C, Sharpe C, Whitney J, Bramham K, Ismail K, Wessely S, Nicholson T, Ashworth A, Humphries A, Tan AL, Whittam B, Coupland C, Favager C, Peckham D, Wade E, Saalmink G, Clarke J, Glossop J, Murira J, Rangeley J, Woods J, Hall L, Dalton M, Window N, Beirne P, Hardy T, Coakley G, Turtle L, Berridge A, Cross A, Key AL, Rowe A, Allt AM, Mears C, Malein F, Madzamba G, Hardwick HE, Earley J, Hawkes J, Pratt J, Wyles J, Tripp KA, Hainey K, Allerton L, Lavelle-Langham L, Melling L, Wajero LO, Poll L, Noonan MJ, French N, Lewis-Burke N, Williams-Howard SA, Cooper S, Kaprowska S, Dobson SL, Marsh S, Highett V, Shaw V, Beadsworth M, Defres S, Watson E, Tiongson GF, Papineni P, Gurram S, Diwanji SN, Quaid S, Briggs A, Hastie C, Rogers N, Stensel D, Bishop L, McIvor K, Rivera-Ortega P, Al-Sheklly B, Avram C, Faluyi D, Blaikely J, Piper Hanley K, Radhakrishnan K, Buch M, Hanley NA, Odell N, Osbourne R, Stockdale S, Felton T, Gorsuch T, Hussell T, Kausar Z, Kabir T, McAllister-Williams H, Paddick S, Burn D, Ayoub A, Greenhalgh A, Sayer A, Young A, Price D, Burns G, MacGowan G, Fisher H, Tedd H, Simpson J, Jiwa K, Witham M, Hogarth P, West S, Wright S, McMahon MJ, Neill P, Dougherty A, Morrow A, Anderson D, Grieve D, Bayes H, Fallon K, Mangion K, Gilmour L, Basu N, Sykes R, Berry C, McInnes IB, Donaldson A, Sage EK, Barrett F, Welsh B, Bell M, Quigley J, Leitch K, Macliver L, Patel M, Hamil R, Deans A, Furniss J, Clohisey S, Elliott A, Solstice AR, Deas C, Tee C, Connell D, Sutherland D, George J, Mohammed S, Bunker J, Holmes K, Dipper A, Morley A, Arnold D, Adamali H, Welch H, Morrison L, Stadon L, Maskell N, Barratt S, Dunn S, Waterson S, Jayaraman B, Light T, Selby N, Hosseini A, Shaw K, Almeida P, Needham R, Thomas AK, Matthews L, Gupta A, Nikolaidis A, Dupont C, Bonnington J, Chrystal M, Greenhaff PL, Linford S, Prosper S, Jang W, Alamoudi A, Bloss A, Megson C, Nicoll D, Fraser E, Pacpaco E, Conneh F, Ogg G, McShane H, Koychev I, Chen J, Pimm J, Ainsworth M, Pavlides M, Sharpe M, Havinden-Williams M, Petousi N, Talbot N, Carter P, Kurupati P, Dong T, Peng Y, Burns A, Kanellakis N, Korszun A, Connolly B, Busby J, Peto T, Patel B, Nolan CM, Cristiano D, Walsh JA, Liyanage K, Gummadi M, Dormand N, Polgar O, George P, Barker RE, Patel S, Price L, Gibbons M, Matila D, Jarvis H, Lim L, Olaosebikan O, Ahmad S, Brill S, Mandal S, Laing C, Michael A, Reddy A, Johnson C, Baxendale H, Parfrey H, Mackie J, Newman J, Pack J, Parmar J, Paques K, Garner L, Harvey A, Summersgill C, Holgate D, Hardy E, Oxton J, Pendlebury J, McMorrow L, Mairs N, Majeed N, Dark P, Ugwuoke R, Knight S, Whittaker S, Strong-Sheldrake S, Matimba-Mupaya W, Chowienczyk P, Pattenadk D, Hurditch E, Chan F, Carborn H, Foot H, Bagshaw J, Hockridge J, Sidebottom J, Lee JH, Birchall K, Turner K, Haslam L, Holt L, Milner L, Begum M, Marshall M, Steele N, Tinker N, Ravencroft P, Butcher R, Misra S, Walker S, Coburn Z, Fairman A, Ford A, Holbourn A, Howell A, Lawrie A, Lye A, Mbuyisa A, Zawia A, Holroyd-Hind B, Thamu B, Clark C, Jarman C, Norman C, Roddis C, Foote D, Lee E, Ilyas F, Stephens G, Newell H, Turton H, Macharia I, Wilson I, Cole J, McNeill J, Meiring J, Rodger J, Watson J, Chapman K, Harrington K, Chetham L, Hesselden L, Nwafor L, Dixon M, Plowright M, Wade P, Gregory R, Lenagh R, Stimpson R, Megson S, Newman T, Cheng Y, Goodwin C, Heeley C, Sissons D, Sowter D, Gregory H, Wynter I, Hutchinson J, Kirk J, Bennett K, Slack K, Allsop L, Holloway L, Flynn M, Gill M, Greatorex M, Holmes M, Buckley P, Shelton S, Turner S, Sewell TA, Whitworth V, Lovegrove W, Tomlinson J, Warburton L, Painter S, Vickers C, Redwood D, Tilley J, Palmer S, Wainwright T, Breen G, Hotopf M, Dunleavy A, Teixeira J, Ali M, Mencias M, Msimanga N, Siddique S, Samakomva T, Tavoukjian V, Forton D, Ahmed R, Cook A, Thaivalappil F, Connor L, Rees T, McNarry M, Williams N, McCormick J, McIntosh J, Vere J, Coulding M, Kilroy S, Turner V, Butt AT, Savill H, Fraile E, Ugoji J, Landers G, Lota H, Portukhay S, Nasseri M, Daniels A, Hormis A, Ingham J, Zeidan L, Osborne L, Chablani M, Banerjee A, David A, Pakzad A, Rangelov B, Williams B, Denneny E, Willoughby J, Xu M, Mehta P, Batterham R, Bell R, Aslani S, Lilaonitkul W, Checkley A, Bang D, Basire D, Lomas D, Wall E, Plant H, Roy K, Heightman M, Lipman M, Merida Morillas M, Ahwireng N, Chambers RC, Jastrub R, Logan S, Hillman T, Botkai A, Casey A, Neal A, Newton-Cox A, Cooper B, Atkin C, McGee C, Welch C, Wilson D, Sapey E, Qureshi H, Hazeldine J, Lord JM, Nyaboko J, Short J, Stockley J, Dasgin J, Draxlbauer K, Isaacs K, Mcgee K, Yip KP, Ratcliffe L, Bates M, Ventura M, Ahmad Haider N, Gautam N, Baggott R, Holden S, Madathil S, Walder S, Yasmin S, Hiwot T, Jackson T, Soulsby T, Kamwa V, Peterkin Z, Suleiman Z, Chaudhuri N, Wheeler H, Djukanovic R, Samuel R, Sass T, Wallis T, Marshall B, Childs C, Marouzet E, Harvey M, Fletcher S, Dickens C, Beckett P, Nanda U, Daynes E, Charalambou A, Yousuf AJ, Lea A, Prickett A, Gooptu B, Hargadon B, Bourne C, Christie C, Edwardson C, Lee D, Baldry E, Stringer E, Woodhead F, Mills G, Arnold H, Aung H, Qureshi IN, Finch J, Skeemer J, Hadley K, Khunti K, Carr L, Ingram L, Aljaroof M, Bakali M, Bakau M, Baldwin M, Bourne M, Pareek M, Soares M, Tobin M, Armstrong N, Brunskill N, Goodman N, Cairns P, Haldar P, McCourt P, Dowling R, Russell R, Diver S, Edwards S, Glover S, Parker S, Siddiqui S, Ward TJC, Mcnally T, Thornton T, Yates T, Ibrahim W, Monteiro W, Thickett D, Wilkinson D, Broome M, McArdle P, Upthegrove R, Wraith D, Langenberg C, Summers C, Bullmore E, Heeney JL, Schwaeble W, Sudlow CL, Adeloye D, Newby DE, Rudan I, Shankar-Hari M, Thorpe M, Pius R, Walmsley S, McGovern A, Ballard C, Allan L, Dennis J, Cavanagh J, Petrie J, O'Donnell K, Spears M, Sattar N, MacDonald S, Guthrie E, Henderson M, Guillen Guio B, Zhao B, Lawson C, Overton C, Taylor C, Tong C, Mukaetova-Ladinska E, Turner E, Pearl JE, Sargant J, Wormleighton J, Bingham M, Sharma M, Steiner M, Samani N, Novotny P, Free R, Allen RJ, Finney S, Terry S, Brugha T, Plekhanova T, McArdle A, Vinson B, Spencer LG, Reynolds W, Ashworth M, Deakin B, Chinoy H, Abel K, Harvie M, Stanel S, Rostron A, Coleman C, Baguley D, Hufton E, Khan F, Hall I, Stewart I, Fabbri L, Wright L, Kitterick P, Morriss R, Johnson S, Bates A, Antoniades C, Clark D, Bhui K, Channon KM, Motohashi K, Sigfrid L, Husain M, Webster M, Fu X, Li X, Kingham L, Klenerman P, Miiler K, Carson G, Simons G, Huneke N, Calder PC, Baldwin D, Bain S, Lasserson D, Daines L, Bright E, Stern M, Crisp P, Dharmagunawardena R, Reddington A, Wight A, Bailey L, Ashish A, Robinson E, Cooper J, Broadley A, Turnbull A, Brookes C, Sarginson C, Ionita D, Redfearn H, Elliott K, Barman L, Griffiths L, Guy Z, Gill R, Nathu R, Harris E, Moss P, Finnigan J, Saunders K, Saunders P, Kon S, Kon SS, O'Brien L, Shah K, Shah P, Richardson E, Brown V, Brown M, Brown J, Brown J, Brown A, Brown A, Brown M, Choudhury N, Jones S, Jones H, Jones L, Jones I, Jones G, Jones H, Jones D, Davies F, Davies E, Davies K, Davies G, Davies GA, Howard K, Porter J, Rowland J, Rowland A, Scott K, Singh S, Singh C, Thomas S, Thomas C, Lewis V, Lewis J, Lewis D, Harrison P, Francis C, Francis R, Hughes RA, Hughes J, Hughes AD, Thompson T, Kelly S, Smith D, Smith N, Smith A, Smith J, Smith L, Smith S, Evans T, Evans RI, Evans D, Evans R, Evans H, Evans J. Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study. Lancet Respir Med 2023; 11:1003-1019. [PMID: 37748493 PMCID: PMC7615263 DOI: 10.1016/s2213-2600(23)00262-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/16/2023] [Accepted: 06/30/2023] [Indexed: 09/27/2023]
Abstract
INTRODUCTION The multiorgan impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multiorgan abnormalities after hospitalisation with COVID-19, evaluate their determinants, and explore associations with patient-related outcome measures. METHODS In a prospective, UK-wide, multicentre MRI follow-up study (C-MORE), adults (aged ≥18 years) discharged from hospital following COVID-19 who were included in Tier 2 of the Post-hospitalisation COVID-19 study (PHOSP-COVID) and contemporary controls with no evidence of previous COVID-19 (SARS-CoV-2 nucleocapsid antibody negative) underwent multiorgan MRI (lungs, heart, brain, liver, and kidneys) with quantitative and qualitative assessment of images and clinical adjudication when relevant. Individuals with end-stage renal failure or contraindications to MRI were excluded. Participants also underwent detailed recording of symptoms, and physiological and biochemical tests. The primary outcome was the excess burden of multiorgan abnormalities (two or more organs) relative to controls, with further adjustments for potential confounders. The C-MORE study is ongoing and is registered with ClinicalTrials.gov, NCT04510025. FINDINGS Of 2710 participants in Tier 2 of PHOSP-COVID, 531 were recruited across 13 UK-wide C-MORE sites. After exclusions, 259 C-MORE patients (mean age 57 years [SD 12]; 158 [61%] male and 101 [39%] female) who were discharged from hospital with PCR-confirmed or clinically diagnosed COVID-19 between March 1, 2020, and Nov 1, 2021, and 52 non-COVID-19 controls from the community (mean age 49 years [SD 14]; 30 [58%] male and 22 [42%] female) were included in the analysis. Patients were assessed at a median of 5·0 months (IQR 4·2-6·3) after hospital discharge. Compared with non-COVID-19 controls, patients were older, living with more obesity, and had more comorbidities. Multiorgan abnormalities on MRI were more frequent in patients than in controls (157 [61%] of 259 vs 14 [27%] of 52; p<0·0001) and independently associated with COVID-19 status (odds ratio [OR] 2·9 [95% CI 1·5-5·8]; padjusted=0·0023) after adjusting for relevant confounders. Compared with controls, patients were more likely to have MRI evidence of lung abnormalities (p=0·0001; parenchymal abnormalities), brain abnormalities (p<0·0001; more white matter hyperintensities and regional brain volume reduction), and kidney abnormalities (p=0·014; lower medullary T1 and loss of corticomedullary differentiation), whereas cardiac and liver MRI abnormalities were similar between patients and controls. Patients with multiorgan abnormalities were older (difference in mean age 7 years [95% CI 4-10]; mean age of 59·8 years [SD 11·7] with multiorgan abnormalities vs mean age of 52·8 years [11·9] without multiorgan abnormalities; p<0·0001), more likely to have three or more comorbidities (OR 2·47 [1·32-4·82]; padjusted=0·0059), and more likely to have a more severe acute infection (acute CRP >5mg/L, OR 3·55 [1·23-11·88]; padjusted=0·025) than those without multiorgan abnormalities. Presence of lung MRI abnormalities was associated with a two-fold higher risk of chest tightness, and multiorgan MRI abnormalities were associated with severe and very severe persistent physical and mental health impairment (PHOSP-COVID symptom clusters) after hospitalisation. INTERPRETATION After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification. FUNDING UK Research and Innovation and National Institute for Health Research.
Collapse
|
9
|
Kerr S, Greenland S, Jeffrey K, Millington T, Bedston S, Ritchie L, Simpson CR, Fagbamigbe AF, Kurdi A, Robertson C, Sheikh A, Rudan I. Understanding and reporting odds ratios as rate-ratio estimates in case-control studies. J Glob Health 2023; 13:04101. [PMID: 37712381 PMCID: PMC10502767 DOI: 10.7189/jogh.13.04101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023] Open
Abstract
Background We noted that there remains some confusion in the health-science literature on reporting sample odds ratios as estimated rate ratios in case-control studies. Methods We recap historical literature that definitively answered the question of when sample odds ratios (ORs) from a case-control study are consistent estimators for population rate ratios. We use numerical examples to illustrate the magnitude of the disparity between sample ORs in a case-control study and population rate ratios when sufficient conditions for them to be equal are not satisfied. Results We stress that in a case-control study, sampling controls from those still at risk at the time of outcome event of the index case is not sufficient for a sample OR to be a consistent estimator for an intelligible rate ratio. In such studies, constancy of the exposure prevalence together with constancy of the hazard ratio (HR) (i.e., the instantaneous rate ratio) over time is sufficient for this result if sampling time is not controlled; if time is controlled, constancy of the HR will suffice. We present numerical examples to illustrate how failure to satisfy these conditions adds a small systematic error to sample ORs as estimates of population rate ratios. Conclusions We recommend that researchers understand and critically evaluate all conditions used to interpret their estimates as consistent for a population parameter in case-control studies.
Collapse
Affiliation(s)
- Steven Kerr
- Centre for Medical Informatics, Usher Institute, The University of Edinburgh, Edinburgh, Scotland, UK
| | - Sander Greenland
- Department of Epidemiology and Department of Statistics, University of California, Los Angeles, California, USA
| | - Karen Jeffrey
- Centre for Medical Informatics, Usher Institute, The University of Edinburgh, Edinburgh, Scotland, UK
| | - Tristan Millington
- Centre for Medical Informatics, Usher Institute, The University of Edinburgh, Edinburgh, Scotland, UK
| | - Stuart Bedston
- Population Data Science, Swansea University Medical School, Swansea, Wales, UK
| | - Lewis Ritchie
- Academic Primary Care, University of Aberdeen School of Medicine and Dentistry, Aberdeen, Scotland, UK
| | - Colin R Simpson
- Wellington Faculty of Health, Victoria University of Wellington, Wellington, NZ
| | - Adeniyi Francis Fagbamigbe
- Institute of Applied Health Sciences, University of Aberdeen School of Medicine and Dentistry, Aberdeen, Scotland, UK
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, Scotland, UK
- Department of Clinical Pharmacy, College of Pharmacy, Hawler Medical University, Erbil, Iraq
- College of Pharmacy, Al-Kitab University, Kirkuk, Iraq
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Chris Robertson
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, Scotland
- Public Health Scotland, Glasgow, Scotland, UK
| | - Aziz Sheikh
- Centre for Medical Informatics, Usher Institute, The University of Edinburgh, Edinburgh, Scotland, UK
| | - Igor Rudan
- Centre for Global Health, Usher Institute, The University of Edinburgh, Edinburgh, Scotland, UK
- University College Algebra, Zagreb, Croatia
| |
Collapse
|
10
|
Pak A, Divol L, Casey DT, Khan SF, Kritcher AL, Ralph JE, Tommasini R, Trosseille C, Zylstra AB, Baker KL, Birge NW, Bionta R, Bachmann B, Dewald EL, Doeppner T, Freeman MS, Fittinghoff DN, Geppert-Kleinrath V, Geppert-Kleinrath H, Hahn KD, Hohenberger M, Holder J, Kerr S, Kim Y, Kozioziemski B, Lamb K, MacGowan BJ, MacPhee AG, Meaney KD, Moore AS, Schlossberg DJ, Stoupin S, Volegov P, Wilde C, Young CV, Landen OL, Town RPJ. Dynamics and Power Balance of Near Unity Target Gain Inertial Confinement Fusion Implosions. Phys Rev Lett 2023; 131:065101. [PMID: 37625041 DOI: 10.1103/physrevlett.131.065101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 07/07/2023] [Indexed: 08/27/2023]
Abstract
The change in the power balance, temporal dynamics, emission weighted size, temperature, mass, and areal density of inertially confined fusion plasmas have been quantified for experiments that reach target gains up to 0.72. It is observed that as the target gain rises, increased rates of self-heating initially overcome expansion power losses. This leads to reacting plasmas that reach peak fusion production at later times with increased size, temperature, mass and with lower emission weighted areal densities. Analytic models are consistent with the observations and inferences for how these quantities evolve as the rate of fusion self-heating, fusion yield, and target gain increase. At peak fusion production, it is found that as temperatures and target gains rise, the expansion power loss increases to a near constant ratio of the fusion self-heating power. This is consistent with models that indicate that the expansion losses dominate the dynamics in this regime.
Collapse
Affiliation(s)
- A Pak
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - L Divol
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - D T Casey
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - S F Khan
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - A L Kritcher
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - J E Ralph
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - R Tommasini
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - C Trosseille
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - A B Zylstra
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - K L Baker
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - N W Birge
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - R Bionta
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - B Bachmann
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - E L Dewald
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - T Doeppner
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - M S Freeman
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - D N Fittinghoff
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | | | | | - K D Hahn
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - M Hohenberger
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - J Holder
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - S Kerr
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - Y Kim
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - B Kozioziemski
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - K Lamb
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - B J MacGowan
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - A G MacPhee
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - K D Meaney
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - A S Moore
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - D J Schlossberg
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - S Stoupin
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - P Volegov
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - C Wilde
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - C V Young
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - O L Landen
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - R P J Town
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| |
Collapse
|
11
|
van der Klaauw AA, Horner EC, Pereyra-Gerber P, Agrawal U, Foster WS, Spencer S, Vergese B, Smith M, Henning E, Ramsay ID, Smith JA, Guillaume SM, Sharpe HJ, Hay IM, Thompson S, Innocentin S, Booth LH, Robertson C, McCowan C, Kerr S, Mulroney TE, O'Reilly MJ, Gurugama TP, Gurugama LP, Rust MA, Ferreira A, Ebrahimi S, Ceron-Gutierrez L, Scotucci J, Kronsteiner B, Dunachie SJ, Klenerman P, Park AJ, Rubino F, Lamikanra AA, Stark H, Kingston N, Estcourt L, Harvala H, Roberts DJ, Doffinger R, Linterman MA, Matheson NJ, Sheikh A, Farooqi IS, Thaventhiran JED. Accelerated waning of the humoral response to COVID-19 vaccines in obesity. Nat Med 2023; 29:1146-1154. [PMID: 37169862 PMCID: PMC10202802 DOI: 10.1038/s41591-023-02343-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 04/07/2023] [Indexed: 05/13/2023]
Abstract
Obesity is associated with an increased risk of severe Coronavirus Disease 2019 (COVID-19) infection and mortality. COVID-19 vaccines reduce the risk of serious COVID-19 outcomes; however, their effectiveness in people with obesity is incompletely understood. We studied the relationship among body mass index (BMI), hospitalization and mortality due to COVID-19 among 3.6 million people in Scotland using the Early Pandemic Evaluation and Enhanced Surveillance of COVID-19 (EAVE II) surveillance platform. We found that vaccinated individuals with severe obesity (BMI > 40 kg/m2) were 76% more likely to experience hospitalization or death from COVID-19 (adjusted rate ratio of 1.76 (95% confidence interval (CI), 1.60-1.94). We also conducted a prospective longitudinal study of a cohort of 28 individuals with severe obesity compared to 41 control individuals with normal BMI (BMI 18.5-24.9 kg/m2). We found that 55% of individuals with severe obesity had unquantifiable titers of neutralizing antibody against authentic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus compared to 12% of individuals with normal BMI (P = 0.0003) 6 months after their second vaccine dose. Furthermore, we observed that, for individuals with severe obesity, at any given anti-spike and anti-receptor-binding domain (RBD) antibody level, neutralizing capacity was lower than that of individuals with a normal BMI. Neutralizing capacity was restored by a third dose of vaccine but again declined more rapidly in people with severe obesity. We demonstrate that waning of COVID-19 vaccine-induced humoral immunity is accelerated in individuals with severe obesity. As obesity is associated with increased hospitalization and mortality from breakthrough infections, our findings have implications for vaccine prioritization policies.
Collapse
Affiliation(s)
- Agatha A van der Klaauw
- University of Cambridge Metabolic Research Laboratories and NIHR Cambridge Biomedical Research Centre, Wellcome-Medical Research Council (MRC) Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Emily C Horner
- MRC Toxicology Unit, University of Cambridge, Cambridge, UK
| | - Pehuén Pereyra-Gerber
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge, Cambridge, UK
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Utkarsh Agrawal
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Sarah Spencer
- MRC Toxicology Unit, University of Cambridge, Cambridge, UK
| | - Bensi Vergese
- University of Cambridge Metabolic Research Laboratories and NIHR Cambridge Biomedical Research Centre, Wellcome-Medical Research Council (MRC) Institute of Metabolic Science, University of Cambridge, Cambridge, UK
- NIHR Cambridge Clinical Research Facility, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Miriam Smith
- University of Cambridge Metabolic Research Laboratories and NIHR Cambridge Biomedical Research Centre, Wellcome-Medical Research Council (MRC) Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Elana Henning
- University of Cambridge Metabolic Research Laboratories and NIHR Cambridge Biomedical Research Centre, Wellcome-Medical Research Council (MRC) Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Isobel D Ramsay
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge, Cambridge, UK
- Department of Medicine, University of Cambridge, Cambridge, UK
- Department of Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Jack A Smith
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge, Cambridge, UK
- Department of Medicine, University of Cambridge, Cambridge, UK
| | | | | | - Iain M Hay
- Babraham Institute, Babraham Research Campus, Cambridge, UK
- Cambridge Institute for Medical Research, University of Cambridge, Cambridge, UK
| | - Sam Thompson
- Babraham Institute, Babraham Research Campus, Cambridge, UK
| | | | - Lucy H Booth
- MRC Toxicology Unit, University of Cambridge, Cambridge, UK
| | - Chris Robertson
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - Colin McCowan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Steven Kerr
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | | | | | | | - Maria A Rust
- MRC Toxicology Unit, University of Cambridge, Cambridge, UK
| | - Alex Ferreira
- MRC Toxicology Unit, University of Cambridge, Cambridge, UK
| | - Soraya Ebrahimi
- Immunology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Clinical Biochemistry, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Lourdes Ceron-Gutierrez
- Immunology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Clinical Biochemistry, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Jacopo Scotucci
- University of Cambridge Metabolic Research Laboratories and NIHR Cambridge Biomedical Research Centre, Wellcome-Medical Research Council (MRC) Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Barbara Kronsteiner
- Peter Medawar Building for Pathogen Research, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Susanna J Dunachie
- Peter Medawar Building for Pathogen Research, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
- NDM Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Translational Gastroenterology Unit, University of Oxford, Oxford, UK
- Mahidol-Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | - Paul Klenerman
- Peter Medawar Building for Pathogen Research, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
- NDM Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Translational Gastroenterology Unit, University of Oxford, Oxford, UK
| | - Adrian J Park
- Clinical Biochemistry, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Francesco Rubino
- Department of Diabetes, King's College London and King's College Hospital NHS Foundation Trust, London, UK
| | - Abigail A Lamikanra
- NHS Blood and Transplant, Oxford, UK
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Hannah Stark
- NIHR BioResource, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Nathalie Kingston
- NIHR BioResource, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Lise Estcourt
- NHS Blood and Transplant, Oxford, UK
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | | | - David J Roberts
- NHS Blood and Transplant, Oxford, UK
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Rainer Doffinger
- Immunology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Clinical Biochemistry, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Nicholas J Matheson
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge, Cambridge, UK
- Department of Medicine, University of Cambridge, Cambridge, UK
- Department of Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- NHS Blood and Transplant, Cambridge, UK
| | - Aziz Sheikh
- Usher Institute, University of Edinburgh, Edinburgh, UK.
| | - I Sadaf Farooqi
- University of Cambridge Metabolic Research Laboratories and NIHR Cambridge Biomedical Research Centre, Wellcome-Medical Research Council (MRC) Institute of Metabolic Science, University of Cambridge, Cambridge, UK.
| | | |
Collapse
|
12
|
Robertson C, Kerr S, Sheikh A. Severity of Omicron BA.5 variant and protective effect of vaccination: national cohort and matched analyses in Scotland. Lancet Reg Health Eur 2023; 28:100638. [PMID: 37124948 PMCID: PMC10139952 DOI: 10.1016/j.lanepe.2023.100638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 03/29/2023] [Accepted: 03/29/2023] [Indexed: 05/03/2023]
Affiliation(s)
| | - Steven Kerr
- University of Edinburgh, Edinburgh, United Kingdom
| | - Aziz Sheikh
- University of Edinburgh, Edinburgh, United Kingdom
| |
Collapse
|
13
|
Bedston S, Lowthian E, Jarvis CI, Akbari A, Beggs J, Bradley D, de Lusignan S, Griffiths R, Herbert L, Hobbs R, Kerr S, Lyons J, Midgley W, Owen RK, Quint JK, Tsang R, Torabi F, Sheikh A, Lyons RA. COVID-19 booster vaccination uptake and infection breakthrough amongst health care workers in Wales: A national prospective cohort study. Vaccine 2023; 41:1378-1389. [PMID: 36669966 PMCID: PMC9837216 DOI: 10.1016/j.vaccine.2023.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/10/2023] [Accepted: 01/11/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND From September 2021, Health Care Workers (HCWs) in Wales began receiving a COVID-19 booster vaccination. This is the first dose beyond the primary vaccination schedule. Given the emergence of new variants, vaccine waning vaccine, and increasing vaccination hesitancy, there is a need to understand booster vaccine uptake and subsequent breakthrough in this high-risk population. METHODS We conducted a prospective, national-scale, observational cohort study of HCWs in Wales using anonymised, linked data from the SAIL Databank. We analysed uptake of COVID-19 booster vaccinations from September 2021 to February 2022, with comparisons against uptake of the initial primary vaccination schedule. We also analysed booster breakthrough, in the form of PCR-confirmed SARS-Cov-2 infection, comparing to the second primary dose. Cox proportional hazard models were used to estimate associations for vaccination uptake and breakthrough regarding staff roles, socio-demographics, household composition, and other factors. RESULTS We derived a cohort of 73,030 HCWs living in Wales (78% female, 60% 18-49 years old). Uptake was quickest amongst HCWs aged 60 + years old (aHR 2.54, 95%CI 2.45-2.63), compared with those aged 18-29. Asian HCWs had quicker uptake (aHR 1.18, 95%CI 1.14-1.22), whilst Black HCWs had slower uptake (aHR 0.67, 95%CI 0.61-0.74), compared to white HCWs. HCWs residing in the least deprived areas were slightly quicker to have received a booster dose (aHR 1.12, 95%CI 1.09-1.16), compared with those in the most deprived areas. Strongest associations with breakthrough infections were found for those living with children (aHR 1.52, 95%CI 1.41-1.63), compared to two-adult only households. HCWs aged 60 + years old were less likely to get breakthrough infections, compared to those aged 18-29 (aHR 0.42, 95%CI 0.38-0.47). CONCLUSION Vaccination uptake was consistently lower among black HCWs, as well as those from deprived areas. Whilst breakthrough infections were highest in households with children.
Collapse
Affiliation(s)
- Stuart Bedston
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, UK.
| | - Emily Lowthian
- Department of Education and Childhood Studies, School of Social Sciences, Swansea University, UK.
| | | | - Ashley Akbari
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, UK.
| | | | - Declan Bradley
- Centre for Public Health, Queen's University Belfast, Belfast, UK. And Public Health Agency, Belfast, UK.
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
| | - Rowena Griffiths
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, UK.
| | - Laura Herbert
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, UK.
| | - Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
| | - Steven Kerr
- Usher Institute, The University of Edinburgh, Edinburgh, UK.
| | - Jane Lyons
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, UK.
| | - William Midgley
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, UK.
| | - Rhiannon K Owen
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, UK.
| | - Jennifer K Quint
- National Heart & Lung Institute, Faculty of Medicine, Imperial College London, UK.
| | - Ruby Tsang
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
| | - Fatemeh Torabi
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, UK.
| | - Aziz Sheikh
- Usher Institute and HDR UK BREATHE Hub, University of Edinburgh, UK.
| | - Ronan A Lyons
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, UK.
| |
Collapse
|
14
|
Kerr S, Bedston S, Bradley DT, Joy M, Lowthian E, Mulholland RM, Akbari A, Hobbs FDR, Katikireddi SV, de Lusignan S, Rudan I, Torabi F, Tsang RSM, Lyons RA, Robertson C, Sheikh A. Waning of first- and second-dose ChAdOx1 and BNT162b2 COVID-19 vaccinations: a pooled target trial study of 12.9 million individuals in England, Northern Ireland, Scotland and Wales. Int J Epidemiol 2023; 52:22-31. [PMID: 36272418 PMCID: PMC9620314 DOI: 10.1093/ije/dyac199] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 09/30/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Several SARS-CoV-2 vaccines have been shown to provide protection against COVID-19 hospitalization and death. However, some evidence suggests that notable waning in effectiveness against these outcomes occurs within months of vaccination. We undertook a pooled analysis across the four nations of the UK to investigate waning in vaccine effectiveness (VE) and relative vaccine effectiveness (rVE) against severe COVID-19 outcomes. METHODS We carried out a target trial design for first/second doses of ChAdOx1(Oxford-AstraZeneca) and BNT162b2 (Pfizer-BioNTech) with a composite outcome of COVID-19 hospitalization or death over the period 8 December 2020 to 30 June 2021. Exposure groups were matched by age, local authority area and propensity for vaccination. We pooled event counts across the four UK nations. RESULTS For Doses 1 and 2 of ChAdOx1 and Dose 1 of BNT162b2, VE/rVE reached zero by approximately Days 60-80 and then went negative. By Day 70, VE/rVE was -25% (95% CI: -80 to 14) and 10% (95% CI: -32 to 39) for Doses 1 and 2 of ChAdOx1, respectively, and 42% (95% CI: 9 to 64) and 53% (95% CI: 26 to 70) for Doses 1 and 2 of BNT162b2, respectively. rVE for Dose 2 of BNT162b2 remained above zero throughout and reached 46% (95% CI: 13 to 67) after 98 days of follow-up. CONCLUSIONS We found strong evidence of waning in VE/rVE for Doses 1 and 2 of ChAdOx1, as well as Dose 1 of BNT162b2. This evidence may be used to inform policies on timings of additional doses of vaccine.
Collapse
Affiliation(s)
- Steven Kerr
- Centre for Medical Informatics, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Stuart Bedston
- Population Data Science, Swansea University Medical School, Swansea University, Swansea, UK
| | - Declan T Bradley
- School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
- Public Health Agency, Belfast, UK
| | - Mark Joy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Emily Lowthian
- Population Data Science, Swansea University Medical School, Swansea University, Swansea, UK
- Department of Education and Childhood Studies, Swansea University, Swansea, UK
| | - Rachel M Mulholland
- Centre for Medical Informatics, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Ashley Akbari
- Population Data Science, Swansea University Medical School, Swansea University, Swansea, UK
| | - F D Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Igor Rudan
- Centre for Medical Informatics, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Fatemeh Torabi
- Population Data Science, Swansea University Medical School, Swansea University, Swansea, UK
| | - Ruby S M Tsang
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Ronan A Lyons
- Population Data Science, Swansea University Medical School, Swansea University, Swansea, UK
| | - Chris Robertson
- Public Health Scotland, Glasgow, UK
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - Aziz Sheikh
- Centre for Medical Informatics, Usher Institute, The University of Edinburgh, Edinburgh, UK
- BREATHE—The Health Data Research Hub for Respiratory Health, The University of Edinburgh, Edinburgh, UK
| |
Collapse
|
15
|
Morgado BE, Sicardy B, Braga-Ribas F, Ortiz JL, Salo H, Vachier F, Desmars J, Pereira CL, Santos-Sanz P, Sfair R, de Santana T, Assafin M, Vieira-Martins R, Gomes-Júnior AR, Margoti G, Dhillon VS, Fernández-Valenzuela E, Broughton J, Bradshaw J, Langersek R, Benedetti-Rossi G, Souami D, Holler BJ, Kretlow M, Boufleur RC, Camargo JIB, Duffard R, Beisker W, Morales N, Lecacheux J, Rommel FL, Herald D, Benz W, Jehin E, Jankowsky F, Marsh TR, Littlefair SP, Bruno G, Pagano I, Brandeker A, Collier-Cameron A, Florén HG, Hara N, Olofsson G, Wilson TG, Benkhaldoun Z, Busuttil R, Burdanov A, Ferrais M, Gault D, Gillon M, Hanna W, Kerr S, Kolb U, Nosworthy P, Sebastian D, Snodgrass C, Teng JP, de Wit J. A dense ring of the trans-Neptunian object Quaoar outside its Roche limit. Nature 2023; 614:239-243. [PMID: 36755175 DOI: 10.1038/s41586-022-05629-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 12/06/2022] [Indexed: 02/10/2023]
Abstract
Planetary rings are observed not only around giant planets1, but also around small bodies such as the Centaur Chariklo2 and the dwarf planet Haumea3. Up to now, all known dense rings were located close enough to their parent bodies, being inside the Roche limit, where tidal forces prevent material with reasonable densities from aggregating into a satellite. Here we report observations of an inhomogeneous ring around the trans-Neptunian body (50000) Quaoar. This trans-Neptunian object has an estimated radius4 of 555 km and possesses a roughly 80-km satellite5 (Weywot) that orbits at 24 Quaoar radii6,7. The detected ring orbits at 7.4 radii from the central body, which is well outside Quaoar's classical Roche limit, thus indicating that this limit does not always determine where ring material can survive. Our local collisional simulations show that elastic collisions, based on laboratory experiments8, can maintain a ring far away from the body. Moreover, Quaoar's ring orbits close to the 1/3 spin-orbit resonance9 with Quaoar, a property shared by Chariklo's2,10,11 and Haumea's3 rings, suggesting that this resonance plays a key role in ring confinement for small bodies.
Collapse
Affiliation(s)
- B E Morgado
- Federal University of Rio de Janeiro - Observatory of Valongo, Rio de Janeiro, Brazil.
- National Observatory/MCTI, Rio de Janeiro, Brazil.
- Interinstitutional e-Astronomy Laboratory (LIneA), Rio de Janeiro, Brazil.
| | - B Sicardy
- LESIA, Observatory of Paris, University PSL, CNRS, UPMC, Sorbonne University, University of Paris Diderot, Sorbonne Paris City, Meudon, France
| | - F Braga-Ribas
- Federal University of Technology, Paraná (UTFPR/DAFIS), Curitiba, Brazil
| | - J L Ortiz
- Institute of Astrophysics at Andalucía, IAA-CSIC, Granada, Spain
| | - H Salo
- Space Physics and Astronomy Research unit, University of Oulu, Oulu, Finland
| | - F Vachier
- The Institute of Celestial Mechanics and Ephemeris Calculation (IMCCE), Observatory of Paris, PSL Research University, CNRS, Sorbonne University, UPMC University of Paris, University of Lille, Lille, France
| | - J Desmars
- The Institute of Celestial Mechanics and Ephemeris Calculation (IMCCE), Observatory of Paris, PSL Research University, CNRS, Sorbonne University, UPMC University of Paris, University of Lille, Lille, France
- Polytechnic Institute of Advanced Sciences (IPSA), Ivry-sur-Seine, France
| | - C L Pereira
- National Observatory/MCTI, Rio de Janeiro, Brazil
- Interinstitutional e-Astronomy Laboratory (LIneA), Rio de Janeiro, Brazil
| | - P Santos-Sanz
- Institute of Astrophysics at Andalucía, IAA-CSIC, Granada, Spain
| | - R Sfair
- Institute for Astronomy and Astrophysics, Eberhard Karls University of Tübingen, Tübingen, Germany
- Orbital Dynamics and Planetology Group, UNESP - São Paulo State University, Guaratinguetá, Brazil
| | - T de Santana
- LESIA, Observatory of Paris, University PSL, CNRS, UPMC, Sorbonne University, University of Paris Diderot, Sorbonne Paris City, Meudon, France
- Orbital Dynamics and Planetology Group, UNESP - São Paulo State University, Guaratinguetá, Brazil
| | - M Assafin
- Federal University of Rio de Janeiro - Observatory of Valongo, Rio de Janeiro, Brazil
- Interinstitutional e-Astronomy Laboratory (LIneA), Rio de Janeiro, Brazil
| | - R Vieira-Martins
- National Observatory/MCTI, Rio de Janeiro, Brazil
- Interinstitutional e-Astronomy Laboratory (LIneA), Rio de Janeiro, Brazil
| | - A R Gomes-Júnior
- Interinstitutional e-Astronomy Laboratory (LIneA), Rio de Janeiro, Brazil
- Orbital Dynamics and Planetology Group, UNESP - São Paulo State University, Guaratinguetá, Brazil
- Institute of Physics, Federal University of Uberlândia, Uberlândia, Brazil
| | - G Margoti
- Federal University of Technology, Paraná (UTFPR/DAFIS), Curitiba, Brazil
| | - V S Dhillon
- Department of Physics and Astronomy, University of Sheffield, Sheffield, UK
- Institute of Astrophysics of The Canary Islands, La Laguna, Spain
| | | | - J Broughton
- Reedy Creek Observatory, Gold Coast, Queensland, Australia
- Trans-Tasman Occultation Alliance (TTOA), Wellington, New Zealand
| | - J Bradshaw
- Samford Valley Observatory (Q79), Brisbane, Queensland, Australia
| | - R Langersek
- Algester Astronomical Observatory, Brisbane, Queensland, Australia
| | - G Benedetti-Rossi
- Interinstitutional e-Astronomy Laboratory (LIneA), Rio de Janeiro, Brazil
- Orbital Dynamics and Planetology Group, UNESP - São Paulo State University, Guaratinguetá, Brazil
| | - D Souami
- LESIA, Observatory of Paris, University PSL, CNRS, UPMC, Sorbonne University, University of Paris Diderot, Sorbonne Paris City, Meudon, France
- Observatory of the Côte d'Azur, Lagrange Laboratory UMR7293 CNRS, Nice, France
- naXys, University of Namur, Namur, Belgium
| | - B J Holler
- Space Telescope Science Institute, Baltimore, MD, USA
| | - M Kretlow
- Institute of Astrophysics at Andalucía, IAA-CSIC, Granada, Spain
- International Occultation Timing Association / European Section, Hannover, Germany
- International Amateur Observatory e.V. (IAS), Mittenwalde, Germany
| | - R C Boufleur
- National Observatory/MCTI, Rio de Janeiro, Brazil
- Interinstitutional e-Astronomy Laboratory (LIneA), Rio de Janeiro, Brazil
| | - J I B Camargo
- National Observatory/MCTI, Rio de Janeiro, Brazil
- Interinstitutional e-Astronomy Laboratory (LIneA), Rio de Janeiro, Brazil
| | - R Duffard
- Institute of Astrophysics at Andalucía, IAA-CSIC, Granada, Spain
| | - W Beisker
- International Occultation Timing Association / European Section, Hannover, Germany
- International Amateur Observatory e.V. (IAS), Mittenwalde, Germany
| | - N Morales
- Institute of Astrophysics at Andalucía, IAA-CSIC, Granada, Spain
| | - J Lecacheux
- LESIA, Observatory of Paris, University PSL, CNRS, UPMC, Sorbonne University, University of Paris Diderot, Sorbonne Paris City, Meudon, France
| | - F L Rommel
- National Observatory/MCTI, Rio de Janeiro, Brazil
- Interinstitutional e-Astronomy Laboratory (LIneA), Rio de Janeiro, Brazil
| | - D Herald
- Trans-Tasman Occultation Alliance (TTOA), Wellington, New Zealand
| | - W Benz
- Institute of Physics, University of Bern, Bern, Switzerland
- Center for Space and Habitability, University of Bern, Bern, Switzerland
| | - E Jehin
- STAR Institute, University of Liège, Liège, Belgium
| | - F Jankowsky
- Heidelberg-Königstuhl State Observatory, Heidelberg, Germany
| | - T R Marsh
- Department of Physics, University of Warwick, Coventry, UK
| | - S P Littlefair
- Department of Physics and Astronomy, University of Sheffield, Sheffield, UK
| | - G Bruno
- INAF, Catania Astrophysical Observatory, Catania, Italy
| | - I Pagano
- INAF, Catania Astrophysical Observatory, Catania, Italy
| | - A Brandeker
- Department of Astronomy, Stockholm University, AlbaNova University Center, Stockholm, Sweden
| | - A Collier-Cameron
- Centre for Exoplanet Science, SUPA School of Physics and Astronomy, University of St Andrews, North Haugh, St Andrews, UK
| | - H G Florén
- Department of Astronomy, Stockholm University, AlbaNova University Center, Stockholm, Sweden
| | - N Hara
- Astronomical Observatory at the University of Geneva, Versoix, Switzerland
| | - G Olofsson
- Department of Astronomy, Stockholm University, AlbaNova University Center, Stockholm, Sweden
| | - T G Wilson
- Centre for Exoplanet Science, SUPA School of Physics and Astronomy, University of St Andrews, North Haugh, St Andrews, UK
| | - Z Benkhaldoun
- Oukaimeden Observatory, High Energy Physics and Astrophysics Laboratory, FSSM, Cadi Ayyad University, Marrakech, Morocco
| | - R Busuttil
- School of Physical Sciences, The Open University, Walton Hall, Milton Keynes, UK
| | - A Burdanov
- Department of Earth, Atmospheric and Planetary Sciences, MIT, Cambridge, MA, USA
| | - M Ferrais
- Laboratory of Astrophysics of Marseille, University of Aix Marseille, CNRS, CNES, Marseille, France
| | - D Gault
- Trans-Tasman Occultation Alliance (TTOA), Wellington, New Zealand
| | - M Gillon
- Astrobiology Research Unit, University of Liège, Liège, Belgium
| | - W Hanna
- Trans-Tasman Occultation Alliance (TTOA), Wellington, New Zealand
| | - S Kerr
- Trans-Tasman Occultation Alliance (TTOA), Wellington, New Zealand
- Astronomical Association of Queensland, Pimpama, Queensland, Australia
| | - U Kolb
- School of Physical Sciences, The Open University, Walton Hall, Milton Keynes, UK
| | - P Nosworthy
- Trans-Tasman Occultation Alliance (TTOA), Wellington, New Zealand
| | - D Sebastian
- School of Physics and Astronomy, University of Birmingham, Birmingham, UK
| | - C Snodgrass
- Institute for Astronomy, University of Edinburgh, Royal Observatory, Edinburgh, UK
| | - J P Teng
- AGORA Observatory of Makes, AGORA, La Rivière, France
| | - J de Wit
- Department of Earth, Atmospheric and Planetary Sciences, MIT, Cambridge, MA, USA
| |
Collapse
|
16
|
Kerr S, Robertson C, Hillman S, Grange Z, Sullivan C, Sheikh A. Severity of BA.2 variant and vaccine effectiveness against symptomatic disease in Scotland. Lancet Reg Health Eur 2022; 23:100533. [PMID: 36373099 PMCID: PMC9635838 DOI: 10.1016/j.lanepe.2022.100533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Steven Kerr
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Chris Robertson
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, United Kingdom
| | - Sam Hillman
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Zoe Grange
- Public Health Scotland, Glasgow, United Kingdom
| | | | - Aziz Sheikh
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| |
Collapse
|
17
|
Rudan I, Millington T, Antal K, Grange Z, Fenton L, Sullivan C, Buelo A, Wood R, Woolford L, Swann OV, Murray JL, Cullen LA, Moore E, Haider F, Almaghrabi F, McMenamin J, Agrawal U, Shah SA, Kerr S, Simpson CR, Katikireddi SV, Ritchie SLD, Robertson C, Sheikh SA. BNT162b2 COVID-19 vaccination uptake, safety, effectiveness and waning in children and young people aged 12-17 years in Scotland. Lancet Reg Health Eur 2022; 23:100513. [PMID: 36189425 PMCID: PMC9514975 DOI: 10.1016/j.lanepe.2022.100513] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background The two-dose BNT162b2 (Pfizer-BioNTech) vaccine has demonstrated high efficacy against COVID-19 disease in clinical trials of children and young people (CYP). Consequently, we investigated the uptake, safety, effectiveness and waning of the protective effect of the BNT162b2 against symptomatic COVID-19 in CYP aged 12-17 years in Scotland. Methods The analysis of the vaccine uptake was based on information from the Turas Vaccination Management Tool, inclusive of Mar 1, 2022. Vaccine safety was evaluated using national data on hospital admissions and General Practice (GP) consultations, through a self-controlled case series (SCCS) design, investigating 17 health outcomes of interest. Vaccine effectiveness (VE) against symptomatic COVID-19 disease for Delta and Omicron variants was estimated using a test-negative design (TND) and S-gene status in a prospective cohort study using the Scotland-wide Early Pandemic Evaluation and Enhanced Surveillance of COVID-19 (EAVE II) surveillance platform. The waning of the VE following each dose of BNT162b2 was assessed using a matching process followed by conditional logistic regression. Findings Between Aug 6, 2021 and Mar 1, 2022, 75.9% of the 112,609 CYP aged 16-17 years received the first and 49.0% the second COVID-19 vaccine dose. Among 237,681 CYP aged 12-15 years, the uptake was 64.5% and 37.2%, respectively. For 12-17-year-olds, BNT162b2 showed an excellent safety record, with no increase in hospital stays following vaccination for any of the 17 investigated health outcomes. In the 16-17-year-old group, VE against symptomatic COVID-19 during the Delta period was 64.2% (95% confidence interval [CI] 59.2-68.5) at 2-5 weeks after the first dose and 95.6% (77.0-99.1) at 2-5 weeks after the second dose. The respective VEs against symptomatic COVID-19 in the Omicron period were 22.8% (95% CI -6.4-44.0) and 65.5% (95% CI 56.0-73.0). In children aged 12-15 years, VE against symptomatic COVID-19 during the Delta period was 65.4% (95% CI 61.5-68.8) at 2-5 weeks after the first dose, with no observed cases at 2-5 weeks after the second dose. The corresponding VE against symptomatic COVID-19 during the Omicron period were 30.2% (95% CI 18.4-40.3) and 81.2% (95% CI 77.7-84.2). The waning of the protective effect against the symptomatic disease began after five weeks post-first and post-second dose. Interpretation During the study period, uptake of BNT162b2 in Scotland has covered more than two-thirds of CYP aged 12-17 years with the first dose and about 40% with the second dose. We found no increased likelihood of admission to hospital with a range of health outcomes in the period after vaccination. Vaccination with both doses was associated with a substantial reduction in the risk of COVID-19 symptomatic disease during both the Delta and Omicron periods, but this protection began to wane after five weeks. Funding UK Research and Innovation (Medical Research Council); Research and Innovation Industrial Strategy Challenge Fund; Chief Scientist's Office of the Scottish Government; Health Data Research UK; National Core Studies - Data and Connectivity.
Collapse
Affiliation(s)
- Igor Rudan
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | | | | | | | | | | | | | - Rachael Wood
- Usher Institute, The University of Edinburgh, Edinburgh, UK
- Public Health Scotland, Glasgow, UK
| | - Lana Woolford
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Olivia V. Swann
- Department of Child Life and Health, University of Edinburgh, Edinburgh, UK
- Royal Hospital for Sick Children, Paediatric Infectious Diseases, Edinburgh, UK
| | | | | | | | - Fasih Haider
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | | | | | - Utkarsh Agrawal
- School of Medicine, University of St Andrews, St Andrews, UK
| | | | - Steven Kerr
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Colin R. Simpson
- School of Health, Wellington Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | | | | | - Chris Robertson
- Public Health Scotland, Glasgow, UK
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | | |
Collapse
|
18
|
Shah SA, Mulholland RH, Wilkinson S, Katikireddi SV, Pan J, Shi T, Kerr S, Agrawal U, Rudan I, Simpson CR, Stock SJ, Macleod J, Murray JLK, McCowan C, Ritchie L, Woolhouse M, Sheikh A. Impact on emergency and elective hospital-based care in Scotland over the first 12 months of the pandemic: interrupted time-series analysis of national lockdowns. J R Soc Med 2022; 115:429-438. [PMID: 35502909 PMCID: PMC9723811 DOI: 10.1177/01410768221095239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 04/07/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES COVID-19 has resulted in the greatest disruption to National Health Service (NHS) care in its over 70-year history. Building on our previous work, we assessed the ongoing impact of pandemic-related disruption on provision of emergency and elective hospital-based care across Scotland over the first year of the pandemic. DESIGN We undertook interrupted time-series analyses to evaluate the impact of ongoing pandemic-related disruption on hospital NHS care provision at national level and across demographics and clinical specialties spanning the period 29 March 2020-28 March 2021. SETTING Scotland, UK. PARTICIPANTS Patients receiving hospital care from NHS Scotland. MAIN OUTCOME MEASURES We used the percentage change of accident and emergency attendances, and emergency and planned hospital admissions during the pandemic compared to the average admission rate for equivalent weeks in 2018-2019. RESULTS As restrictions were gradually lifted in Scotland after the first lockdown, hospital-based admissions increased approaching pre-pandemic levels. Subsequent tightening of restrictions in September 2020 were associated with a change in slope of relative weekly admissions rate: -1.98% (-2.38, -1.58) in accident and emergency attendance, -1.36% (-1.68, -1.04) in emergency admissions and -2.31% (-2.95, -1.66) in planned admissions. A similar pattern was seen across sex, socioeconomic status and most age groups, except children (0-14 years) where accident and emergency attendance, and emergency admissions were persistently low over the study period. CONCLUSIONS We found substantial disruption to urgent and planned inpatient healthcare provision in hospitals across NHS Scotland. There is the need for urgent policy responses to address continuing unmet health needs and to ensure resilience in the context of future pandemics.
Collapse
Affiliation(s)
- Syed Ahmar Shah
- Usher Institute, Edinburgh Medical School, University of
Edinburgh, Edinburgh, EH16 4UX UK
| | - Rachel H Mulholland
- Usher Institute, Edinburgh Medical School, University of
Edinburgh, Edinburgh, EH16 4UX UK
| | - Samantha Wilkinson
- Usher Institute, Edinburgh Medical School, University of
Edinburgh, Edinburgh, EH16 4UX UK
| | | | - Jiafeng Pan
- Department of Mathematics and Statistics, University of
Strathclyde, Glasgow, G1 1XH UK
| | - Ting Shi
- Usher Institute, Edinburgh Medical School, University of
Edinburgh, Edinburgh, EH16 4UX UK
| | - Steven Kerr
- Usher Institute, Edinburgh Medical School, University of
Edinburgh, Edinburgh, EH16 4UX UK
| | - Uktarsh Agrawal
- School of Medicine, University of St. Andrews, St Andrews, KY16
9TF UK
| | - Igor Rudan
- Usher Institute, Edinburgh Medical School, University of
Edinburgh, Edinburgh, EH16 4UX UK
| | - Colin R Simpson
- Usher Institute, Edinburgh Medical School, University of
Edinburgh, Edinburgh, EH16 4UX UK
- School of Health, Wellington Faculty of Health, Victoria
University of Wellington, PO Box 600,Wellington 6140 New Zealand
| | - Sarah J Stock
- Usher Institute, Edinburgh Medical School, University of
Edinburgh, Edinburgh, EH16 4UX UK
| | - John Macleod
- The National Institute for Health Research Applied Research
Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston
NHS Foundation Trust, Bristol, BS1 2NT, UK
| | | | - Colin McCowan
- School of Medicine, University of St. Andrews, St Andrews, KY16
9TF UK
| | - Lewis Ritchie
- Academic Primary Care, University of Aberdeen School of Medicine
and Dentistry, Aberdeen, AB24 3FX UK
| | - Mark Woolhouse
- Usher Institute, Edinburgh Medical School, University of
Edinburgh, Edinburgh, EH16 4UX UK
| | - Aziz Sheikh
- Usher Institute, Edinburgh Medical School, University of
Edinburgh, Edinburgh, EH16 4UX UK
| |
Collapse
|
19
|
Kerr S, Eckart MJ, Hahn K, Hartouni EP, Jeet J, Landen OL, Moore AS, Schlossberg DJ. Construction and study of instrument response functions for analysis of the National Ignition Facility (NIF) neutron time-of-flight detectors. Rev Sci Instrum 2022; 93:113550. [PMID: 36461502 DOI: 10.1063/5.0101868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 10/25/2022] [Indexed: 06/17/2023]
Abstract
The analysis of the National Ignition Facility (NIF) neutron time-of-flight (nToF) detectors uses a forward-fit routine that depends critically on the instrument response functions (IRFs) of the diagnostics. The details of the IRFs used can have large impacts on measurements such as ion temperature and down-scattered ratio (DSR). Here, we report on the recent steps taken to construct and validate nToF IRFs at the NIF to an increased degree of accuracy, as well as remove the need for fixed DSR baseline offsets. The IRF is treated in two parts: a "core," measured experimentally with an x-ray impulse source, and a "tail" that occurs later in time and has limited experimental data. The tail region is calibrated with the data from indirect drive exploding pusher shots, which have little neutron scattering and are traditionally assumed to have zero DSR. Using analytic modeling estimates, the non-zero DSR for these shots is estimated. The impact of varying IRF tail components on DSR is investigated with a systematic parameter study, and good agreement is found with the non-zero DSR estimates. These approaches will be used to improve the precision and uncertainty of NIF nToF DSR measurements.
Collapse
Affiliation(s)
- S Kerr
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - M J Eckart
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - K Hahn
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - E P Hartouni
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - J Jeet
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - O L Landen
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - A S Moore
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - D J Schlossberg
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| |
Collapse
|
20
|
Agrawal U, Bedston S, McCowan C, Oke J, Patterson L, Robertson C, Akbari A, Azcoaga-Lorenzo A, Bradley DT, Fagbamigbe AF, Grange Z, Hall ECR, Joy M, Katikireddi SV, Kerr S, Ritchie L, Murphy S, Owen RK, Rudan I, Shah SA, Simpson CR, Torabi F, Tsang RSM, de Lusignan S, Lyons RA, O'Reilly D, Sheikh A. Severe COVID-19 outcomes after full vaccination of primary schedule and initial boosters: pooled analysis of national prospective cohort studies of 30 million individuals in England, Northern Ireland, Scotland, and Wales. Lancet 2022; 400:1305-1320. [PMID: 36244382 PMCID: PMC9560746 DOI: 10.1016/s0140-6736(22)01656-7] [Citation(s) in RCA: 100] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/11/2022] [Accepted: 08/24/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Current UK vaccination policy is to offer future COVID-19 booster doses to individuals at high risk of serious illness from COVID-19, but it is still uncertain which groups of the population could benefit most. In response to an urgent request from the UK Joint Committee on Vaccination and Immunisation, we aimed to identify risk factors for severe COVID-19 outcomes (ie, COVID-19-related hospitalisation or death) in individuals who had completed their primary COVID-19 vaccination schedule and had received the first booster vaccine. METHODS We constructed prospective cohorts across all four UK nations through linkages of primary care, RT-PCR testing, vaccination, hospitalisation, and mortality data on 30 million people. We included individuals who received primary vaccine doses of BNT162b2 (tozinameran; Pfizer-BioNTech) or ChAdOx1 nCoV-19 (Oxford-AstraZeneca) vaccines in our initial analyses. We then restricted analyses to those given a BNT162b2 or mRNA-1273 (elasomeran; Moderna) booster and had a severe COVID-19 outcome between Dec 20, 2021, and Feb 28, 2022 (when the omicron (B.1.1.529) variant was dominant). We fitted time-dependent Poisson regression models and calculated adjusted rate ratios (aRRs) and 95% CIs for the associations between risk factors and COVID-19-related hospitalisation or death. We adjusted for a range of potential covariates, including age, sex, comorbidities, and previous SARS-CoV-2 infection. Stratified analyses were conducted by vaccine type. We then did pooled analyses across UK nations using fixed-effect meta-analyses. FINDINGS Between Dec 8, 2020, and Feb 28, 2022, 16 208 600 individuals completed their primary vaccine schedule and 13 836 390 individuals received a booster dose. Between Dec 20, 2021, and Feb 28, 2022, 59 510 (0·4%) of the primary vaccine group and 26 100 (0·2%) of those who received their booster had severe COVID-19 outcomes. The risk of severe COVID-19 outcomes reduced after receiving the booster (rate change: 8·8 events per 1000 person-years to 7·6 events per 1000 person-years). Older adults (≥80 years vs 18-49 years; aRR 3·60 [95% CI 3·45-3·75]), those with comorbidities (≥5 comorbidities vs none; 9·51 [9·07-9·97]), being male (male vs female; 1·23 [1·20-1·26]), and those with certain underlying health conditions-in particular, individuals receiving immunosuppressants (yes vs no; 5·80 [5·53-6·09])-and those with chronic kidney disease (stage 5 vs no; 3·71 [2·90-4·74]) remained at high risk despite the initial booster. Individuals with a history of COVID-19 infection were at reduced risk (infected ≥9 months before booster dose vs no previous infection; aRR 0·41 [95% CI 0·29-0·58]). INTERPRETATION Older people, those with multimorbidity, and those with specific underlying health conditions remain at increased risk of COVID-19 hospitalisation and death after the initial vaccine booster and should, therefore, be prioritised for additional boosters, including novel optimised versions, and the increasing array of COVID-19 therapeutics. FUNDING National Core Studies-Immunity, UK Research and Innovation (Medical Research Council), Health Data Research UK, the Scottish Government, and the University of Edinburgh.
Collapse
Affiliation(s)
- Utkarsh Agrawal
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Stuart Bedston
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health, and Life Science, Swansea University, Swansea, UK
| | - Colin McCowan
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Jason Oke
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Lynsey Patterson
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Chris Robertson
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK; Public Health Scotland, Glasgow, UK
| | - Ashley Akbari
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health, and Life Science, Swansea University, Swansea, UK
| | | | - Declan T Bradley
- Centre for Public Health, Queen's University Belfast, Belfast, UK; Public Health Agency, Belfast, UK
| | | | | | | | - Mark Joy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Steven Kerr
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Lewis Ritchie
- Academic Primary Care, University of Aberdeen School of Medicine and Dentistry, Aberdeen, UK
| | - Siobhán Murphy
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Rhiannon K Owen
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health, and Life Science, Swansea University, Swansea, UK
| | - Igor Rudan
- Centre of Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK; Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | - Colin R Simpson
- Usher Institute, University of Edinburgh, Edinburgh, UK; Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Fatemeh Torabi
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health, and Life Science, Swansea University, Swansea, UK
| | - Ruby S M Tsang
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Ronan A Lyons
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health, and Life Science, Swansea University, Swansea, UK
| | - Dermot O'Reilly
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Aziz Sheikh
- Usher Institute, University of Edinburgh, Edinburgh, UK.
| |
Collapse
|
21
|
Hohenberger M, Kerr S, Yeamans C, Rusby D, Meaney KD, Hahn K, Heredia R, Sarginson T, Blue B, Mackinnon AJ, Hsing WW. A combined MeV-neutron and x-ray source for the National Ignition Facility. Rev Sci Instrum 2022; 93:103510. [PMID: 36319336 DOI: 10.1063/5.0101816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 08/11/2022] [Indexed: 06/16/2023]
Abstract
In support of future radiation-effects testing, a combined environment source has been developed for the National Ignition Facility (NIF), utilizing both NIF's long-pulse beams, and the Advanced Radiographic Capability (ARC) short pulse lasers. First, ARC was used to illuminate a gold foil at high-intensity, generating a significant x-ray signal >1 MeV. This was followed by NIF 10 ns later to implode an exploding pusher target filled with fusionable gas for neutron generation. The neutron and x-ray bursts were incident onto a retrievable, close-standoff diagnostic snout. With separate control over both neutron and x-ray emission, the platform allows for tailored photon and neutron fluences and timing on a recoverable test sample. The platform exceeded its initial fluence goals, demonstrating a neutron fluence of 2.3 ×1013 n/cm2 and an x-ray dose of 7 krad.
Collapse
Affiliation(s)
- M Hohenberger
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - S Kerr
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - C Yeamans
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - D Rusby
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - K D Meaney
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - K Hahn
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - R Heredia
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - T Sarginson
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - B Blue
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - A J Mackinnon
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - W W Hsing
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| |
Collapse
|
22
|
Shi T, Pan J, Moore E, Katikireddi SV, Docherty AB, Fenton L, McCowan C, Agrawal U, Kerr S, Shah SA, Stock SJ, Simpson CR, Robertson C, Sheikh A. Risk of COVID-19 hospitalizations among school-aged children in Scotland: A national incident cohort study. J Glob Health 2022; 12:05044. [PMID: 36134546 PMCID: PMC9494196 DOI: 10.7189/jogh.12.05044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background There is considerable policy, clinical and public interest about whether children should be vaccinated against SARS-CoV-2 and, if so, which children should be prioritised (particularly if vaccine resources are limited). To inform such deliberations, we sought to identify children and young people at highest risk of hospitalization from COVID-19. Methods We used the Early Pandemic Evaluation and Enhanced Surveillance of COVID-19 (EAVE II) platform to undertake a national incident cohort analysis to investigate the risk of hospitalization among 5-17 years old living in Scotland in risk groups defined by the living risk prediction algorithm (QCOVID). A Cox proportional hazard model was used to derive hazard ratios (HR) and 95% confidence intervals (CIs) for the association between risk groups and COVID-19 hospital admission. Adjustments were made for age, sex, socioeconomic status, co-morbidity, and prior hospitalization. Results Between March 1, 2020 and November 22, 2021, there were 146 183 (19.4% of all 752 867 children in Scotland) polymerase chain reaction (PCR) confirmed SARS-CoV-2 infections among 5-17 years old. Of those with confirmed infection, 973 (0.7%) were admitted to hospital with COVID-19. The rate of COVID-19 hospitalization was higher in those within each QCOVID risk group compared to those without the condition. Similar results were found in age stratified analyses (5-11 and 12-17 years old). Risk groups associated with an increased risk of COVID-19 hospital admission, included (adjusted HR, 95% CIs): sickle cell disease 14.35 (8.48-24.28), chronic kidney disease 11.34 (4.61-27.87), blood cancer 6.32 (3.24-12.35), rare pulmonary diseases 5.04 (2.58-9.86), type 2 diabetes 3.04 (1.34-6.92), epilepsy 2.54 (1.69-3.81), type 1 diabetes 2.48 (1.47-4.16), Down syndrome 2.45 (0.96-6.25), cerebral palsy 2.37 (1.26-4.47), severe mental illness 1.43 (0.63-3.24), fracture 1.41 (1.02-1.95), congenital heart disease 1.35 (0.82-2.23), asthma 1.28 (1.06-1.55), and learning disability (excluding Down syndrome) 1.08 (0.82-1.42), when compared to those without these conditions. Although our Cox models were adjusted for a number of potential confounders, residual confounding remains a possibility. Conclusions In this national study, we observed an increased risk of COVID-19 hospital admissions among school-aged children with specific underlying long-term health conditions compared with children without these conditions.
Collapse
Affiliation(s)
- Ting Shi
- Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, Scotland, UK
| | - Jiafeng Pan
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, Scotland, UK
| | - Emily Moore
- Public Health Scotland, Glasgow, Scotland, UK
| | | | - Annemarie B Docherty
- Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, Scotland, UK
| | | | - Colin McCowan
- School of Medicine, University of St Andrews, St Andrews, Scotland, UK
| | - Utkarsh Agrawal
- School of Medicine, University of St Andrews, St Andrews, Scotland, UK
| | - Steven Kerr
- Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, Scotland, UK
| | - Syed Ahmar Shah
- Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, Scotland, UK
| | - Sarah J Stock
- Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, Scotland, UK
| | - Colin R Simpson
- Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, Scotland, UK
- School of Health, Wellington Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Chris Robertson
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, Scotland, UK
- Public Health Scotland, Glasgow, Scotland, UK
| | - Aziz Sheikh
- Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, Scotland, UK
| | - Public Health Scotland and the EAVE II Collaborators
- Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, Scotland, UK
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, Scotland, UK
- Public Health Scotland, Glasgow, Scotland, UK
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, Scotland, UK
- School of Medicine, University of St Andrews, St Andrews, Scotland, UK
- School of Health, Wellington Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| |
Collapse
|
23
|
Simpson CR, Kerr S, Katikireddi SV, McCowan C, Ritchie LD, Pan J, Stock SJ, Rudan I, Tsang RSM, de Lusignan S, Hobbs FDR, Akbari A, Lyons RA, Robertson C, Sheikh A. Second-dose ChAdOx1 and BNT162b2 COVID-19 vaccines and thrombocytopenic, thromboembolic and hemorrhagic events in Scotland. Nat Commun 2022; 13:4800. [PMID: 35970827 PMCID: PMC9377297 DOI: 10.1038/s41467-022-32264-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 07/22/2022] [Indexed: 01/07/2023] Open
Abstract
We investigated thrombocytopenic, thromboembolic and hemorrhagic events following a second dose of ChAdOx1 and BNT162b2 using a self-controlled case series analysis. We used a national prospective cohort with 2.0 million(m) adults vaccinated with two doses of ChAdOx or 1.6 m with BNT162b2. The incidence rate ratio (IRR) for idiopathic thrombocytopenic purpura (ITP) 14-20 days post-ChAdOx1 second dose was 2.14, 95% confidence interval (CI) 0.90-5.08. The incidence of ITP post-second dose ChAdOx1 was 0.59 (0.37-0.89) per 100,000 doses. No evidence of an increased risk of CVST was found for the 0-27 day risk period (IRR 0.83, 95% CI 0.16 to 4.26). However, few (≤5) events arose within this risk period. It is perhaps noteworthy that these events all clustered in the 7-13 day period (IRR 4.06, 95% CI 0.94 to 17.51). No other associations were found for second dose ChAdOx1, or any association for second dose BNT162b2 vaccination. Second dose ChAdOx1 vaccination was associated with increased borderline risks of ITP and CVST events. However, these events were rare thus providing reassurance about the safety of these vaccines. Further analyses including more cases are required to determine more precisely the risk profile for ITP and CVST after a second dose of ChAdOx1 vaccine.
Collapse
Affiliation(s)
- Colin R Simpson
- School of Health, Wellington Faculty of Health, Victoria University of Wellington, Wellington, New Zealand.
- Usher Institute, The University of Edinburgh, Edinburgh, UK.
- Public Health Scotland, Edinburgh, UK.
| | - Steven Kerr
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Srinivasa Vittal Katikireddi
- Public Health Scotland, Edinburgh, UK
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Colin McCowan
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Lewis D Ritchie
- Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK
| | - Jiafeng Pan
- Department of Mathematics and Statistics, University of Strathclyde, Strathclyde, UK
| | - Sarah J Stock
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Igor Rudan
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Ruby S M Tsang
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - F D Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Ashley Akbari
- Population Data Science, Swansea University, Swansea, UK
| | - Ronan A Lyons
- Population Data Science, Swansea University, Swansea, UK
| | - Chris Robertson
- Public Health Scotland, Edinburgh, UK
- Department of Mathematics and Statistics, University of Strathclyde, Strathclyde, UK
| | - Aziz Sheikh
- Usher Institute, The University of Edinburgh, Edinburgh, UK.
- Health Data Research UK, BREATHE Hub, London, UK.
| |
Collapse
|
24
|
Evans RA, Leavy OC, Richardson M, Elneima O, McAuley HJC, Shikotra A, Singapuri A, Sereno M, Saunders RM, Harris VC, Houchen-Wolloff L, Aul R, Beirne P, Bolton CE, Brown JS, Choudhury G, Diar-Bakerly N, Easom N, Echevarria C, Fuld J, Hart N, Hurst J, Jones MG, Parekh D, Pfeffer P, Rahman NM, Rowland-Jones SL, Shah AM, Wootton DG, Chalder T, Davies MJ, De Soyza A, Geddes JR, Greenhalf W, Greening NJ, Heaney LG, Heller S, Howard LS, Jacob J, Jenkins RG, Lord JM, Man WDC, McCann GP, Neubauer S, Openshaw PJM, Porter JC, Rowland MJ, Scott JT, Semple MG, Singh SJ, Thomas DC, Toshner M, Lewis KE, Thwaites RS, Briggs A, Docherty AB, Kerr S, Lone NI, Quint J, Sheikh A, Thorpe M, Zheng B, Chalmers JD, Ho LP, Horsley A, Marks M, Poinasamy K, Raman B, Harrison EM, Wain LV, Brightling CE, Abel K, Adamali H, Adeloye D, Adeyemi O, Adrego R, Aguilar Jimenez LA, Ahmad S, Ahmad Haider N, Ahmed R, Ahwireng N, Ainsworth M, Al-Sheklly B, Alamoudi A, Ali M, Aljaroof M, All AM, Allan L, Allen RJ, Allerton L, Allsop L, Almeida P, Altmann D, Alvarez Corral M, Amoils S, Anderson D, Antoniades C, Arbane G, Arias A, Armour C, Armstrong L, Armstrong N, Arnold D, Arnold H, Ashish A, Ashworth A, Ashworth M, Aslani S, Assefa-Kebede H, Atkin C, Atkin P, Aung H, Austin L, Avram C, Ayoub A, Babores M, Baggott R, Bagshaw J, Baguley D, Bailey L, Baillie JK, Bain S, Bakali M, Bakau M, Baldry E, Baldwin D, Ballard C, Banerjee A, Bang B, Barker RE, Barman L, Barratt S, Barrett F, Basire D, Basu N, Bates M, Bates A, Batterham R, Baxendale H, Bayes H, Beadsworth M, Beckett P, Beggs M, Begum M, Bell D, Bell R, Bennett K, Beranova E, Bermperi A, Berridge A, Berry C, Betts S, Bevan E, Bhui K, Bingham M, Birchall K, Bishop L, Bisnauthsing K, Blaikely J, Bloss A, Bolger A, Bonnington J, Botkai A, Bourne C, Bourne M, Bramham K, Brear L, Breen G, Breeze J, Bright E, Brill S, Brindle K, Broad L, Broadley A, Brookes C, Broome M, Brown A, Brown A, Brown J, Brown J, Brown M, Brown M, Brown V, Brugha T, Brunskill N, Buch M, Buckley P, Bularga A, Bullmore E, Burden L, Burdett T, Burn D, Burns G, Burns A, Busby J, Butcher R, Butt A, Byrne S, Cairns P, Calder PC, Calvelo E, Carborn H, Card B, Carr C, Carr L, Carson G, Carter P, Casey A, Cassar M, Cavanagh J, Chablani M, Chambers RC, Chan F, Channon KM, Chapman K, Charalambou A, Chaudhuri N, Checkley A, Chen J, Cheng Y, Chetham L, Childs C, Chilvers ER, Chinoy H, Chiribiri A, Chong-James K, Choudhury N, Chowienczyk P, Christie C, Chrystal M, Clark D, Clark C, Clarke J, Clohisey S, Coakley G, Coburn Z, Coetzee S, Cole J, Coleman C, Conneh F, Connell D, Connolly B, Connor L, Cook A, Cooper B, Cooper J, Cooper S, Copeland D, Cosier T, Coulding M, Coupland C, Cox E, Craig T, Crisp P, Cristiano D, Crooks MG, Cross A, Cruz I, Cullinan P, Cuthbertson D, Daines L, Dalton M, Daly P, Daniels A, Dark P, Dasgin J, David A, David C, Davies E, Davies F, Davies G, Davies GA, Davies K, Dawson J, Daynes E, Deakin B, Deans A, Deas C, Deery J, Defres S, Dell A, Dempsey K, Denneny E, Dennis J, Dewar A, Dharmagunawardena R, Dickens C, Dipper A, Diver S, Diwanji SN, Dixon M, Djukanovic R, Dobson H, Dobson SL, Donaldson A, Dong T, Dormand N, Dougherty A, Dowling R, Drain S, Draxlbauer K, Drury K, Dulawan P, Dunleavy A, Dunn S, Earley J, Edwards S, Edwardson C, El-Taweel H, Elliott A, Elliott K, Ellis Y, Elmer A, Evans D, Evans H, Evans J, Evans R, Evans RI, Evans T, Evenden C, Evison L, Fabbri L, Fairbairn S, Fairman A, Fallon K, Faluyi D, Favager C, Fayzan T, Featherstone J, Felton T, Finch J, Finney S, Finnigan J, Finnigan L, Fisher H, Fletcher S, Flockton R, Flynn M, Foot H, Foote D, Ford A, Forton D, Fraile E, Francis C, Francis R, Francis S, Frankel A, Fraser E, Free R, French N, Fu X, Furniss J, Garner L, Gautam N, George J, George P, Gibbons M, Gill M, Gilmour L, Gleeson F, Glossop J, Glover S, Goodman N, Goodwin C, Gooptu B, Gordon H, Gorsuch T, Greatorex M, Greenhaff PL, Greenhalgh A, Greenwood J, Gregory H, Gregory R, Grieve D, Griffin D, Griffiths L, Guerdette AM, Guillen Guio B, Gummadi M, Gupta A, Gurram S, Guthrie E, Guy Z, H Henson H, Hadley K, Haggar A, Hainey K, Hairsine B, Haldar P, Hall I, Hall L, Halling-Brown M, Hamil R, Hancock A, Hancock K, Hanley NA, Haq S, Hardwick HE, Hardy E, Hardy T, Hargadon B, Harrington K, Harris E, Harrison P, Harvey A, Harvey M, Harvie M, Haslam L, Havinden-Williams M, Hawkes J, Hawkings N, Haworth J, Hayday A, Haynes M, Hazeldine J, Hazelton T, Heeley C, Heeney JL, Heightman M, Henderson M, Hesselden L, Hewitt M, Highett V, Hillman T, Hiwot T, Hoare A, Hoare M, Hockridge J, Hogarth P, Holbourn A, Holden S, Holdsworth L, Holgate D, Holland M, Holloway L, Holmes K, Holmes M, Holroyd-Hind B, Holt L, Hormis A, Hosseini A, Hotopf M, Howard K, Howell A, Hufton E, Hughes AD, Hughes J, Hughes R, Humphries A, Huneke N, Hurditch E, Husain M, Hussell T, Hutchinson J, Ibrahim W, Ilyas F, Ingham J, Ingram L, Ionita D, Isaacs K, Ismail K, Jackson T, James WY, Jarman C, Jarrold I, Jarvis H, Jastrub R, Jayaraman B, Jezzard P, Jiwa K, Johnson C, Johnson S, Johnston D, Jolley CJ, Jones D, Jones G, Jones H, Jones H, Jones I, Jones L, Jones S, Jose S, Kabir T, Kaltsakas G, Kamwa V, Kanellakis N, Kaprowska S, Kausar Z, Keenan N, Kelly S, Kemp G, Kerslake H, Key AL, Khan F, Khunti K, Kilroy S, King B, King C, Kingham L, Kirk J, Kitterick P, Klenerman P, Knibbs L, Knight S, Knighton A, Kon O, Kon S, Kon SS, Koprowska S, Korszun A, Koychev I, Kurasz C, Kurupati P, Laing C, Lamlum H, Landers G, Langenberg C, Lasserson D, Lavelle-Langham L, Lawrie A, Lawson C, Lawson C, Layton A, Lea A, Lee D, Lee JH, Lee E, Leitch K, Lenagh R, Lewis D, Lewis J, Lewis V, Lewis-Burke N, Li X, Light T, Lightstone L, Lilaonitkul W, Lim L, Linford S, Lingford-Hughes A, Lipman M, Liyanage K, Lloyd A, Logan S, Lomas D, Loosley R, Lota H, Lovegrove W, Lucey A, Lukaschuk E, Lye A, Lynch C, MacDonald S, MacGowan G, Macharia I, Mackie J, Macliver L, Madathil S, Madzamba G, Magee N, Magtoto MM, Mairs N, Majeed N, Major E, Malein F, Malim M, Mallison G, Mandal S, Mangion K, Manisty C, Manley R, March K, Marciniak S, Marino P, Mariveles M, Marouzet E, Marsh S, Marshall B, Marshall M, Martin J, Martineau A, Martinez LM, Maskell N, Matila D, Matimba-Mupaya W, Matthews L, Mbuyisa A, McAdoo S, Weir McCall J, McAllister-Williams H, McArdle A, McArdle P, McAulay D, McCormick J, McCormick W, McCourt P, McGarvey L, McGee C, Mcgee K, McGinness J, McGlynn K, McGovern A, McGuinness H, McInnes IB, McIntosh J, McIvor E, McIvor K, McLeavey L, McMahon A, McMahon MJ, McMorrow L, Mcnally T, McNarry M, McNeill J, McQueen A, McShane H, Mears C, Megson C, Megson S, Mehta P, Meiring J, Melling L, Mencias M, Menzies D, Merida Morillas M, Michael A, Milligan L, Miller C, Mills C, Mills NL, Milner L, Misra S, Mitchell J, Mohamed A, Mohamed N, Mohammed S, Molyneaux PL, Monteiro W, Moriera S, Morley A, Morrison L, Morriss R, Morrow A, Moss AJ, Moss P, Motohashi K, Msimanga N, Mukaetova-Ladinska E, Munawar U, Murira J, Nanda U, Nassa H, Nasseri M, Neal A, Needham R, Neill P, Newell H, Newman T, Newton-Cox A, Nicholson T, Nicoll D, Nolan CM, Noonan MJ, Norman C, Novotny P, Nunag J, Nwafor L, Nwanguma U, Nyaboko J, O'Donnell K, O'Brien C, O'Brien L, O'Regan D, Odell N, Ogg G, Olaosebikan O, Oliver C, Omar Z, Orriss-Dib L, Osborne L, Osbourne R, Ostermann M, Overton C, Owen J, Oxton J, Pack J, Pacpaco E, Paddick S, Painter S, Pakzad A, Palmer S, Papineni P, Paques K, Paradowski K, Pareek M, Parfrey H, Pariante C, Parker S, Parkes M, Parmar J, Patale S, Patel B, Patel M, Patel S, Pattenadk D, Pavlides M, Payne S, Pearce L, Pearl JE, Peckham D, Pendlebury J, Peng Y, Pennington C, Peralta I, Perkins E, Peterkin Z, Peto T, Petousi N, Petrie J, Phipps J, Pimm J, Piper Hanley K, Pius R, Plant H, Plein S, Plekhanova T, Plowright M, Polgar O, Poll L, Porter J, Portukhay S, Powell N, Prabhu A, Pratt J, Price A, Price C, Price C, Price D, Price L, Price L, Prickett A, Propescu J, Pugmire S, Quaid S, Quigley J, Qureshi H, Qureshi IN, Radhakrishnan K, Ralser M, Ramos A, Ramos H, Rangeley J, Rangelov B, Ratcliffe L, Ravencroft P, Reddington A, Reddy R, Redfearn H, Redwood D, Reed A, Rees M, Rees T, Regan K, Reynolds W, Ribeiro C, Richards A, Richardson E, Rivera-Ortega P, Roberts K, Robertson E, Robinson E, Robinson L, Roche L, Roddis C, Rodger J, Ross A, Ross G, Rossdale J, Rostron A, Rowe A, Rowland A, Rowland J, Roy K, Roy M, Rudan I, Russell R, Russell E, Saalmink G, Sabit R, Sage EK, Samakomva T, Samani N, Sampson C, Samuel K, Samuel R, Sanderson A, Sapey E, Saralaya D, Sargant J, Sarginson C, Sass T, Sattar N, Saunders K, Saunders P, Saunders LC, Savill H, Saxon W, Sayer A, Schronce J, Schwaeble W, Scott K, Selby N, Sewell TA, Shah K, Shah P, Shankar-Hari M, Sharma M, Sharpe C, Sharpe M, Shashaa S, Shaw A, Shaw K, Shaw V, Shelton S, Shenton L, Shevket K, Short J, Siddique S, Siddiqui S, Sidebottom J, Sigfrid L, Simons G, Simpson J, Simpson N, Singh C, Singh S, Sissons D, Skeemer J, Slack K, Smith A, Smith D, Smith S, Smith J, Smith L, Soares M, Solano TS, Solly R, Solstice AR, Soulsby T, Southern D, Sowter D, Spears M, Spencer LG, Speranza F, Stadon L, Stanel S, Steele N, Steiner M, Stensel D, Stephens G, Stephenson L, Stern M, Stewart I, Stimpson R, Stockdale S, Stockley J, Stoker W, Stone R, Storrar W, Storrie A, Storton K, Stringer E, Strong-Sheldrake S, Stroud N, Subbe C, Sudlow CL, Suleiman Z, Summers C, Summersgill C, Sutherland D, Sykes DL, Sykes R, Talbot N, Tan AL, Tarusan L, Tavoukjian V, Taylor A, Taylor C, Taylor J, Te A, Tedd H, Tee CJ, Teixeira J, Tench H, Terry S, Thackray-Nocera S, Thaivalappil F, Thamu B, Thickett D, Thomas C, Thomas S, Thomas AK, Thomas-Woods T, Thompson T, Thompson AAR, Thornton T, Tilley J, Tinker N, Tiongson GF, Tobin M, Tomlinson J, Tong C, Touyz R, Tripp KA, Tunnicliffe E, Turnbull A, Turner E, Turner S, Turner V, Turner K, Turney S, Turtle L, Turton H, Ugoji J, Ugwuoke R, Upthegrove R, Valabhji J, Ventura M, Vere J, Vickers C, Vinson B, Wade E, Wade P, Wainwright T, Wajero LO, Walder S, Walker S, Walker S, Wall E, Wallis T, Walmsley S, Walsh JA, Walsh S, Warburton L, Ward TJC, Warwick K, Wassall H, Waterson S, Watson E, Watson L, Watson J, Welch C, Welch H, Welsh B, Wessely S, West S, Weston H, Wheeler H, White S, Whitehead V, Whitney J, Whittaker S, Whittam B, Whitworth V, Wight A, Wild J, Wilkins M, Wilkinson D, Williams N, Williams N, Williams J, Williams-Howard SA, Willicombe M, Willis G, Willoughby J, Wilson A, Wilson D, Wilson I, Window N, Witham M, Wolf-Roberts R, Wood C, Woodhead F, Woods J, Wormleighton J, Worsley J, Wraith D, Wrey Brown C, Wright C, Wright L, Wright S, Wyles J, Wynter I, Xu M, Yasmin N, Yasmin S, Yates T, Yip KP, Young B, Young S, Young A, Yousuf AJ, Zawia A, Zeidan L, Zhao B, Zongo O. Clinical characteristics with inflammation profiling of long COVID and association with 1-year recovery following hospitalisation in the UK: a prospective observational study. Lancet Respir Med 2022; 10:761-775. [PMID: 35472304 PMCID: PMC9034855 DOI: 10.1016/s2213-2600(22)00127-8] [Citation(s) in RCA: 144] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/23/2022] [Accepted: 03/31/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND No effective pharmacological or non-pharmacological interventions exist for patients with long COVID. We aimed to describe recovery 1 year after hospital discharge for COVID-19, identify factors associated with patient-perceived recovery, and identify potential therapeutic targets by describing the underlying inflammatory profiles of the previously described recovery clusters at 5 months after hospital discharge. METHODS The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a prospective, longitudinal cohort study recruiting adults (aged ≥18 years) discharged from hospital with COVID-19 across the UK. Recovery was assessed using patient-reported outcome measures, physical performance, and organ function at 5 months and 1 year after hospital discharge, and stratified by both patient-perceived recovery and recovery cluster. Hierarchical logistic regression modelling was performed for patient-perceived recovery at 1 year. Cluster analysis was done using the clustering large applications k-medoids approach using clinical outcomes at 5 months. Inflammatory protein profiling was analysed from plasma at the 5-month visit. This study is registered on the ISRCTN Registry, ISRCTN10980107, and recruitment is ongoing. FINDINGS 2320 participants discharged from hospital between March 7, 2020, and April 18, 2021, were assessed at 5 months after discharge and 807 (32·7%) participants completed both the 5-month and 1-year visits. 279 (35·6%) of these 807 patients were women and 505 (64·4%) were men, with a mean age of 58·7 (SD 12·5) years, and 224 (27·8%) had received invasive mechanical ventilation (WHO class 7-9). The proportion of patients reporting full recovery was unchanged between 5 months (501 [25·5%] of 1965) and 1 year (232 [28·9%] of 804). Factors associated with being less likely to report full recovery at 1 year were female sex (odds ratio 0·68 [95% CI 0·46-0·99]), obesity (0·50 [0·34-0·74]) and invasive mechanical ventilation (0·42 [0·23-0·76]). Cluster analysis (n=1636) corroborated the previously reported four clusters: very severe, severe, moderate with cognitive impairment, and mild, relating to the severity of physical health, mental health, and cognitive impairment at 5 months. We found increased inflammatory mediators of tissue damage and repair in both the very severe and the moderate with cognitive impairment clusters compared with the mild cluster, including IL-6 concentration, which was increased in both comparisons (n=626 participants). We found a substantial deficit in median EQ-5D-5L utility index from before COVID-19 (retrospective assessment; 0·88 [IQR 0·74-1·00]), at 5 months (0·74 [0·64-0·88]) to 1 year (0·75 [0·62-0·88]), with minimal improvements across all outcome measures at 1 year after discharge in the whole cohort and within each of the four clusters. INTERPRETATION The sequelae of a hospital admission with COVID-19 were substantial 1 year after discharge across a range of health domains, with the minority in our cohort feeling fully recovered. Patient-perceived health-related quality of life was reduced at 1 year compared with before hospital admission. Systematic inflammation and obesity are potential treatable traits that warrant further investigation in clinical trials. FUNDING UK Research and Innovation and National Institute for Health Research.
Collapse
|
25
|
Kerr S, Vasileiou E, Robertson C, Sheikh A. COVID-19 vaccine effectiveness against symptomatic SARS-CoV-2 infection and severe COVID-19 outcomes from Delta AY.4.2: Cohort and test-negative study of 5.4 million individuals in Scotland. J Glob Health 2022; 12:05025. [PMID: 35802764 PMCID: PMC9269984 DOI: 10.7189/jogh.12.05025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background In July 2021, a new variant of SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) in the Delta lineage was detected in the United Kingdom (UK), named AY.4.2 or "Delta plus". By October 2021, the AY.4.2 variant accounted for approximately 10-11% of cases in the UK. AY.4.2 was designated as a variant under investigation by the UK Health and Security Agency on 20 October 2021. This study aimed to investigate vaccine effectiveness (VE) against symptomatic COVID-19 (Coronavirus disease 2019) infection and COVID-19 hospitalisation/death for the AY.4.2 variant. Methods We used the Scotland-wide Early Pandemic Evaluation and Enhanced Surveillance (EAVE-II) platform to estimate the VE of the ChAdOx1, BNT162b2, and mRNA-1273 vaccines against symptomatic infection and severe COVID-19 outcomes in adults. The study was conducted from June 8 to October 25, 2021. We used a test-negative design (TND) to estimate VE against reverse transcriptase polymerase chain reaction (RT-PCR) confirmed symptomatic SARS-CoV-2 infection while adjusting for sex, socioeconomic status, number of coexisting conditions, and splines in time and age. We also performed a cohort study using a Cox proportional hazards model to estimate VE against a composite outcome of COVID-19 hospital admission or death, with the same adjustments. Results We found an overall VE against symptomatic SARS-CoV-2 infection due to AY.4.2 of 73% (95% confidence interval (CI) = 62-81) for >14 days post-second vaccine dose. Good protection against AY.4.2 symptomatic infection was observed for BNT162b2, ChAdOx1, and mRNA-1273. In unvaccinated individuals, the hazard ratio (HR) for COVID-19 hospital admission or death from AY.4.2 among community detected cases was 1.77 (95% CI = 1.02-3.07) relative to unvaccinated individuals who were infected with Delta, after adjusting for multiple potential confounders. VE against AY.4.2 COVID-19 admissions or deaths was 87% (95% CI = 74-93) >28 days post-second vaccination relative to unvaccinated. Conclusions We found that AY.4.2 was associated with an increased risk of COVID-19 hospitalisations or deaths in unvaccinated individuals compared with Delta and that vaccination provided substantial protection against symptomatic SARS-CoV-2 and severe COVID-19 outcomes following Delta AY.4.2 infection. High levels of vaccine uptake and protection offered by existing vaccines, as well as the rapid emergence of the Omicron variant may have contributed to the AY.4.2 variant never progressing to a variant of concern.
Collapse
Affiliation(s)
- Steven Kerr
- Usher Institute, The University of Edinburgh, Edinburgh, Scotland, UK
| | | | - Chris Robertson
- University of Strathclyde, Glasgow, United Kingdom; Public Health Scotland, Glasgow, Scotland, UK
| | - Aziz Sheikh
- Usher Institute, The University of Edinburgh, Edinburgh, Scotland, UK
| |
Collapse
|
26
|
Daines L, Mulholland RH, Vasileiou E, Hammersley V, Weatherill D, Katikireddi SV, Kerr S, Moore E, Pesenti E, Quint JK, Shah SA, Shi T, Simpson CR, Robertson C, Sheikh A. Deriving and validating a risk prediction model for long COVID-19: protocol for an observational cohort study using linked Scottish data. BMJ Open 2022; 12:e059385. [PMID: 35793922 PMCID: PMC9260199 DOI: 10.1136/bmjopen-2021-059385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 06/17/2022] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION COVID-19 is commonly experienced as an acute illness, yet some people continue to have symptoms that persist for weeks, or months (commonly referred to as 'long-COVID'). It remains unclear which patients are at highest risk of developing long-COVID. In this protocol, we describe plans to develop a prediction model to identify individuals at risk of developing long-COVID. METHODS AND ANALYSIS We will use the national Early Pandemic Evaluation and Enhanced Surveillance of COVID-19 (EAVE II) platform, a population-level linked dataset of routine electronic healthcare data from 5.4 million individuals in Scotland. We will identify potential indicators for long-COVID by identifying patterns in primary care data linked to information from out-of-hours general practitioner encounters, accident and emergency visits, hospital admissions, outpatient visits, medication prescribing/dispensing and mortality. We will investigate the potential indicators of long-COVID by performing a matched analysis between those with a positive reverse transcriptase PCR (RT-PCR) test for SARS-CoV-2 infection and two control groups: (1) individuals with at least one negative RT-PCR test and never tested positive; (2) the general population (everyone who did not test positive) of Scotland. Cluster analysis will then be used to determine the final definition of the outcome measure for long-COVID. We will then derive, internally and externally validate a prediction model to identify the epidemiological risk factors associated with long-COVID. ETHICS AND DISSEMINATION The EAVE II study has obtained approvals from the Research Ethics Committee (reference: 12/SS/0201), and the Public Benefit and Privacy Panel for Health and Social Care (reference: 1920-0279). Study findings will be published in peer-reviewed journals and presented at conferences. Understanding the predictors for long-COVID and identifying the patient groups at greatest risk of persisting symptoms will inform future treatments and preventative strategies for long-COVID.
Collapse
Affiliation(s)
- Luke Daines
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | | | | | | | | | | | - Steven Kerr
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Emily Moore
- Public Health Scotland, Glasgow and Edinburgh, UK
| | - Elisa Pesenti
- Institute of Cell Biology, University of Edinburgh, Edinburgh, UK
| | - Jennifer K Quint
- Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, UK
| | | | - Ting Shi
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Colin R Simpson
- Usher Institute, The University of Edinburgh, Edinburgh, UK
- School of Health, Wellington Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Chris Robertson
- Public Health Scotland, Glasgow and Edinburgh, UK
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - Aziz Sheikh
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| |
Collapse
|
27
|
Sun P, Bartlett CS, Zheng C, Bigwarfe T, Grant JM, MacDougall M, Berger V, Kerr S, Qian HS, McHugh M, Chen H, Zhang X, Carpenter ML, Robinson HN, Miglietta J, Lamla T, Fryer RM. E ffect of Novel Biotherapeutic Elevating Angiopoietin 1 on Progression of Diabetic Nephropathy in Diabetic/Obese Mice. J Pharmacol Exp Ther 2022; 382:266-276. [PMID: 35779860 DOI: 10.1124/jpet.121.001067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 06/14/2022] [Indexed: 11/22/2022] Open
Abstract
Diabetic nephropathy is a leading cause of end stage renal disease, characterized by endothelial dysfunction and compromised glomerular permeability barrier. Dysregulation of the ANGPT1/ANGPT2 signaling axis is implicated in disease progression. We recently described the discovery of an IgG1 antibody, O010, with therapeutic potential to elevate circulating endogenous ANGPT1, a TIE2 agonist. We detail the effect of various ANGPT1 elevating strategies to limit progression of renal dysfunction in diabetic-obese (db/db) mice. We demonstrate that AAV- or DNA minicircle-directed overexpression of ANGPT1 elicits a reduction in albuminuria (56-73%) and an improvement in histopathology score (18% reduction in glomerulosclerosis). An improved acetylcholine response in isolated aortic rings was also observed indicative of a benefit on vascular function. In separate pharmacokinetic studies an efficacious dose of the ANGPT1 DNA minicircle increased circulating levels of the protein by >80% resulting in a concomitant suppression of ANGPT2. At a dose of O010 producing maximal elevation of circulating ANGPT1 achievable with the molecule (60% increase), no suppression of ANGPT2 was observed in db/db suggesting insufficient pathway engagement; no reduction in albuminuria or improvement in histopathological outcomes were observed. To pinpoint the mechanism resulting in lack of efficacy we demonstrate using confocal microscopy an interference with TIE2 translocation to adherens junctions resulting in a loss of protection against vascular permeability normally conferred by ANGPT1. Results demonstrate the essential importance of ANGPT1 to maintain the glomerular permeability barrier, and due to interference of O010 with this process, led to the discontinuation of the molecule for clinical development. Significance Statement This body of original research demonstrates that elevation of systemic angiopoietin 1 is protective against diabetic nephropathy. However, using a novel biotherapeutic approach to elevate systemic ANGPT1 renoprotection was not observed; we demonstrate that protection was lost due to interference of the therapeutic with ANGPT1/TIE2 translocation to adherens junctions. Thus, the clinical development of the antibody was terminated.
Collapse
Affiliation(s)
- Peng Sun
- Cardiometabolic Diseases Research, Boehringer Ingelheim Pharmaceuticals, Inc., United States
| | | | - Chao Zheng
- Boehringer Ingelheim Pharmaceuticals, Inc., United States
| | - Tammy Bigwarfe
- Boehringer Ingelheim Pharmaceuticals, Inc., United States
| | | | | | | | - Steven Kerr
- Boehringer Ingelheim Pharmaceuticals, Inc., United States
| | - Hu Sheng Qian
- Boehringer Ingelheim Pharmaceuticals, Inc., United States
| | - Mark McHugh
- Boehringer Ingelheim Pharmaceuticals, Inc., United States
| | - Hongxing Chen
- Boehringer Ingelheim Pharmaceuticals, Inc., United States
| | - Xiaomei Zhang
- Boehringer Ingelheim Pharmaceuticals, Inc., United States
| | | | | | - John Miglietta
- Boehringer Ingelheim Pharmaceuticals, Inc., United States
| | | | - Ryan M Fryer
- Cardiometabolic Diseases Research, Boehringer Ingelheim Pharmaceuticals, Inc, United States
| |
Collapse
|
28
|
Kerr S, Robertson C, Nafilyan V, Lyons RA, Kee F, Cardwell CR, Coupland C, Lyons J, Humberstone B, Hippisley-Cox J, Sheikh A. Common protocol for validation of the QCOVID algorithm across the four UK nations. BMJ Open 2022; 12:e050994. [PMID: 35701053 PMCID: PMC9198386 DOI: 10.1136/bmjopen-2021-050994] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 05/31/2022] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The QCOVID algorithm is a risk prediction tool for infection and subsequent hospitalisation/death due to SARS-CoV-2. At the time of writing, it is being used in important policy-making decisions by the UK and devolved governments for combatting the COVID-19 pandemic, including deliberations on shielding and vaccine prioritisation. There are four statistical validations exercises currently planned for the QCOVID algorithm, using data pertaining to England, Northern Ireland, Scotland and Wales, respectively. This paper presents a common procedure for conducting and reporting on validation exercises for the QCOVID algorithm. METHODS AND ANALYSIS We will use open, retrospective cohort studies to assess the performance of the QCOVID risk prediction tool in each of the four UK nations. Linked datasets comprising of primary and secondary care records, virological testing data and death registrations will be assembled in trusted research environments in England, Scotland, Northern Ireland and Wales. We will seek to have population level coverage as far as possible within each nation. The following performance metrics will be calculated by strata: Harrell's C, Brier Score, R2 and Royston's D. ETHICS AND DISSEMINATION Approvals have been obtained from relevant ethics bodies in each UK nation. Findings will be made available to national policy-makers, presented at conferences and published in peer-reviewed journal.
Collapse
Affiliation(s)
- Steven Kerr
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Chris Robertson
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | | | - Ronan A Lyons
- Swansea Clinical School, University of Wales Swansea, Swansea, UK
| | - Frank Kee
- UKCRC Centre of Excellence for Public Health (NI), Queen's University Belfast, Belfast, UK
| | - Christopher R Cardwell
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Carol Coupland
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Jane Lyons
- Population Data Science, Swansea University Medical School, Swansea, UK
| | | | - Julia Hippisley-Cox
- Nuffield Department of Primary Care Sciences, University of Oxford, Oxford, UK
| | - Aziz Sheikh
- Usher Institute, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
29
|
Simpson CR, Robertson C, Kerr S, Shi T, Vasileiou E, Moore E, McCowan C, Agrawal U, Docherty A, Mulholland R, Murray J, Ritchie LD, McMenamin J, Hippisley-Cox J, Sheikh A. External validation of the QCovid risk prediction algorithm for risk of COVID-19 hospitalisation and mortality in adults: national validation cohort study in Scotland. Thorax 2022; 77:497-504. [PMID: 34782484 PMCID: PMC8595052 DOI: 10.1136/thoraxjnl-2021-217580] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 10/11/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The QCovid algorithm is a risk prediction tool that can be used to stratify individuals by risk of COVID-19 hospitalisation and mortality. Version 1 of the algorithm was trained using data covering 10.5 million patients in England in the period 24 January 2020 to 30 April 2020. We carried out an external validation of version 1 of the QCovid algorithm in Scotland. METHODS We established a national COVID-19 data platform using individual level data for the population of Scotland (5.4 million residents). Primary care data were linked to reverse-transcription PCR (RT-PCR) virology testing, hospitalisation and mortality data. We assessed the performance of the QCovid algorithm in predicting COVID-19 hospitalisations and deaths in our dataset for two time periods matching the original study: 1 March 2020 to 30 April 2020, and 1 May 2020 to 30 June 2020. RESULTS Our dataset comprised 5 384 819 individuals, representing 99% of the estimated population (5 463 300) resident in Scotland in 2020. The algorithm showed good calibration in the first period, but systematic overestimation of risk in the second period, prior to temporal recalibration. Harrell's C for deaths in females and males in the first period was 0.95 (95% CI 0.94 to 0.95) and 0.93 (95% CI 0.92 to 0.93), respectively. Harrell's C for hospitalisations in females and males in the first period was 0.81 (95% CI 0.80 to 0.82) and 0.82 (95% CI 0.81 to 0.82), respectively. CONCLUSIONS Version 1 of the QCovid algorithm showed high levels of discrimination in predicting the risk of COVID-19 hospitalisations and deaths in adults resident in Scotland for the original two time periods studied, but is likely to need ongoing recalibration prospectively.
Collapse
Affiliation(s)
- Colin R Simpson
- School of Health, Victoria University of Wellington, Wellington, New Zealand
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Chris Robertson
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - Steven Kerr
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Ting Shi
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | | | - Emily Moore
- Information Services Division, Public Health Scotland, Edinburgh, UK
| | - Colin McCowan
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Utkarsh Agrawal
- School of Medicine, University of St Andrews, St Andrews, UK
| | | | | | - Josie Murray
- Health Protection Scotland, Public Health Scotland, Glasgow, UK
| | | | - Jim McMenamin
- Health Protection Scotland, Public Health Scotland, Glasgow, UK
| | | | - Aziz Sheikh
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| |
Collapse
|
30
|
Sheikh A, Kerr S, Woolhouse M, McMenamin J, Robertson C. Severity of omicron variant of concern and effectiveness of vaccine boosters against symptomatic disease in Scotland (EAVE II): a national cohort study with nested test-negative design. The Lancet Infectious Diseases 2022; 22:959-966. [PMID: 35468332 PMCID: PMC9033213 DOI: 10.1016/s1473-3099(22)00141-4] [Citation(s) in RCA: 136] [Impact Index Per Article: 68.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/02/2022] [Accepted: 02/16/2022] [Indexed: 12/12/2022]
Abstract
Background Since its emergence in November, 2021, in southern Africa, the SARS-CoV-2 omicron variant of concern (VOC) has rapidly spread across the world. We aimed to investigate the severity of omicron and the extent to which booster vaccines are effective in preventing symptomatic infection. Methods In this study, using the Scotland-wide Early Pandemic Evaluation and Enhanced Surveillance of COVID-19 (EAVE II) platform, we did a cohort analysis with a nested test-negative design incident case-control study covering the period Nov 1–Dec 19, 2021, to provide initial estimates of omicron severity and the effectiveness of vaccine boosters against symptomatic disease relative to 25 weeks or more after the second vaccine dose. Primary care data derived from 940 general practices across Scotland were linked to laboratory data and hospital admission data. We compared outcomes between infection with the delta VOC (defined as S-gene positive) and the omicron VOC (defined as S-gene negative). We assessed effectiveness against symptomatic SARS-CoV-2 infection, with infection confirmed through a positive RT-PCR. Findings By Dec 19, 2021, there were 23 840 S-gene-negative cases in Scotland, which were predominantly among those aged 20–39 years (11 732 [49·2%]). The proportion of S-gene-negative cases that were possible reinfections was more than ten times that of S-gene-positive cases (7·6% vs 0·7%; p<0·0001). There were 15 hospital admissions in S-gene-negative individuals, giving an adjusted observed-to-expected admissions ratio of 0·32 (95% CI 0·19–0·52). The booster vaccine dose was associated with a 57% (54–60) reduction in the risk of symptomatic S-gene-negative infection relative to individuals who tested positive 25 weeks or more after the second vaccine dose. Interpretation These early national data suggest that omicron is associated with a two-thirds reduction in the risk of COVID-19 hospitalisation compared with delta. Although offering the greatest protection against delta, the booster dose of vaccination offers substantial additional protection against the risk of symptomatic COVID-19 for omicron compared with 25 weeks or more after the second vaccine dose. Funding Health Data Research UK, National Core Studies, Public Health Scotland, Scottish Government, UK Research and Innovation, and University of Edinburgh.
Collapse
Affiliation(s)
- Aziz Sheikh
- Usher Institute, University of Edinburgh, Edinburgh, UK.
| | - Steven Kerr
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | | | - Chris Robertson
- Public Health Scotland, Glasgow, UK; Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| |
Collapse
|
31
|
Vasileiou E, Shi T, Kerr S, Robertson C, Joy M, Tsang R, McGagh D, Williams J, Hobbs R, de Lusignan S, Bradley D, OReilly D, Murphy S, Chuter A, Beggs J, Ford D, Orton C, Akbari A, Bedston S, Davies G, Griffiths LJ, Griffiths R, Lowthian E, Lyons J, Lyons RA, North L, Perry M, Torabi F, Pickett J, McMenamin J, McCowan C, Agrawal U, Wood R, Stock SJ, Moore E, Henery P, Simpson CR, Sheikh A. Investigating the uptake, effectiveness and safety of COVID-19 vaccines: protocol for an observational study using linked UK national data. BMJ Open 2022; 12:e050062. [PMID: 35165107 PMCID: PMC8844955 DOI: 10.1136/bmjopen-2021-050062] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 01/19/2022] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The novel coronavirus SARS-CoV-2, which emerged in December 2019, has caused millions of deaths and severe illness worldwide. Numerous vaccines are currently under development of which a few have now been authorised for population-level administration by several countries. As of 20 September 2021, over 48 million people have received their first vaccine dose and over 44 million people have received their second vaccine dose across the UK. We aim to assess the uptake rates, effectiveness, and safety of all currently approved COVID-19 vaccines in the UK. METHODS AND ANALYSIS We will use prospective cohort study designs to assess vaccine uptake, effectiveness and safety against clinical outcomes and deaths. Test-negative case-control study design will be used to assess vaccine effectiveness (VE) against laboratory confirmed SARS-CoV-2 infection. Self-controlled case series and retrospective cohort study designs will be carried out to assess vaccine safety against mild-to-moderate and severe adverse events, respectively. Individual-level pseudonymised data from primary care, secondary care, laboratory test and death records will be linked and analysed in secure research environments in each UK nation. Univariate and multivariate logistic regression models will be carried out to estimate vaccine uptake levels in relation to various population characteristics. VE estimates against laboratory confirmed SARS-CoV-2 infection will be generated using a generalised additive logistic model. Time-dependent Cox models will be used to estimate the VE against clinical outcomes and deaths. The safety of the vaccines will be assessed using logistic regression models with an offset for the length of the risk period. Where possible, data will be meta-analysed across the UK nations. ETHICS AND DISSEMINATION We obtained approvals from the National Research Ethics Service Committee, Southeast Scotland 02 (12/SS/0201), the Secure Anonymised Information Linkage independent Information Governance Review Panel project number 0911. Concerning English data, University of Oxford is compliant with the General Data Protection Regulation and the National Health Service (NHS) Digital Data Security and Protection Policy. This is an approved study (Integrated Research Application ID 301740, Health Research Authority (HRA) Research Ethics Committee 21/HRA/2786). The Oxford-Royal College of General Practitioners Clinical Informatics Digital Hub meets NHS Digital's Data Security and Protection Toolkit requirements. In Northern Ireland, the project was approved by the Honest Broker Governance Board, project number 0064. Findings will be made available to national policy-makers, presented at conferences and published in peer-reviewed journals.
Collapse
Affiliation(s)
| | - Ting Shi
- The University of Edinburgh, Usher Institute, Edinburgh, UK
| | - Steven Kerr
- The University of Edinburgh, Usher Institute, Edinburgh, UK
| | - Chris Robertson
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
- Public Health Scotland, Glasgow, UK
| | - Mark Joy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Ruby Tsang
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Dylan McGagh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - John Williams
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Declan Bradley
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Dermot OReilly
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Siobhan Murphy
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Antony Chuter
- BREATHE - The Health Data Research Hub for Respiratory Health, London, UK
| | - Jillian Beggs
- BREATHE - The Health Data Research Hub for Respiratory Health, London, UK
| | - David Ford
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Chris Orton
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Ashley Akbari
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Stuart Bedston
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Gareth Davies
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Lucy J Griffiths
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Rowena Griffiths
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Emily Lowthian
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Jane Lyons
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Ronan A Lyons
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Laura North
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Malorie Perry
- Vaccine Preventable Disease Programme, Public Health Wales, Cardiff, UK
| | - Fatemeh Torabi
- Population Data Science, Swansea University Medical School, Swansea, UK
| | | | | | - Colin McCowan
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Utkarsh Agrawal
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Rachael Wood
- The University of Edinburgh, Usher Institute, Edinburgh, UK
- Public Health Scotland, Edinburgh, UK
| | - Sarah Jane Stock
- The University of Edinburgh, Usher Institute, Edinburgh, UK
- Public Health Scotland, Edinburgh, UK
| | | | - Paul Henery
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Colin R Simpson
- The University of Edinburgh, Usher Institute, Edinburgh, UK
- Wellington School of Health, Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Aziz Sheikh
- The University of Edinburgh, Usher Institute, Edinburgh, UK
| |
Collapse
|
32
|
Shi T, Pan J, Katikireddi SV, McCowan C, Kerr S, Agrawal U, Shah SA, Simpson CR, Ritchie LD, Robertson C, Sheikh A. Risk of COVID-19 hospital admission among children aged 5-17 years with asthma in Scotland: a national incident cohort study. Lancet Respir Med 2022; 10:191-198. [PMID: 34861180 PMCID: PMC8631918 DOI: 10.1016/s2213-2600(21)00491-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/27/2021] [Accepted: 10/27/2021] [Indexed: 02/09/2023]
Abstract
BACKGROUND There is an urgent need to inform policy deliberations about whether children with asthma should be vaccinated against SARS-CoV-2 and, if so, which subset of children with asthma should be prioritised. We were asked by the UK's Joint Commission on Vaccination and Immunisation to undertake an urgent analysis to identify which children with asthma were at increased risk of serious COVID-19 outcomes. METHODS This national incident cohort study was done in all children in Scotland aged 5-17 years who were included in the linked dataset of Early Pandemic Evaluation and Enhanced Surveillance of COVID-19 (EAVE II). We used data from EAVE II to investigate the risk of COVID-19 hospitalisation among children with markers of uncontrolled asthma defined by either previous asthma hospital admission or oral corticosteroid prescription in the previous 2 years. A Cox proportional hazard model was used to derive hazard ratios (HRs) and 95% CIs for the association between asthma and COVID-19 hospital admission, stratified by markers of asthma control (previous asthma hospital admission and number of previous prescriptions for oral corticosteroids within 2 years of the study start date). Analyses were adjusted for age, sex, socioeconomic status, comorbidity, and previous hospital admission. FINDINGS Between March 1, 2020, and July 27, 2021, 752 867 children were included in the EAVE II dataset, 63 463 (8·4%) of whom had clinician-diagnosed-and-recorded asthma. Of these, 4339 (6·8%) had RT-PCR confirmed SARS-CoV-2 infection. In those with confirmed infection, 67 (1·5%) were admitted to hospital with COVID-19. Among the 689 404 children without asthma, 40 231 (5·8%) had confirmed SARS-CoV-2 infections, of whom 382 (0·9%) were admitted to hospital with COVID-19. The rate of COVID-19 hospital admission was higher in children with poorly controlled asthma than in those with well controlled asthma or without asthma. When using previous hospital admission for asthma as the marker of uncontrolled asthma, the adjusted HR was 6·40 (95% CI 3·27-12·53) for those with poorly controlled asthma and 1·36 (1·02-1·80) for those with well controlled asthma, compared with those with no asthma. When using oral corticosteroid prescriptions as the marker of uncontrolled asthma, the adjusted HR was 3·38 (1·84-6·21) for those with three or more prescribed courses of corticosteroids, 3·53 (1·87-6·67) for those with two prescribed courses of corticosteroids, 1·52 (0·90-2·57) for those with one prescribed course of corticosteroids, and 1·34 (0·98-1·82) for those with no prescribed course, compared with those with no asthma. INTERPRETATION School-aged children with asthma with previous recent hospital admission or two or more courses of oral corticosteroids are at markedly increased risk of COVID-19 hospital admission and should be considered a priority for vaccinations. This would translate into 9124 children across Scotland and an estimated 109 448 children across the UK. FUNDING UK Research and Innovation (Medical Research Council), Research and Innovation Industrial Strategy Challenge Fund, Health Data Research UK, and Scottish Government.
Collapse
Affiliation(s)
- Ting Shi
- Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | - Jiafeng Pan
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | | | - Colin McCowan
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Steven Kerr
- Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | - Utkarsh Agrawal
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Syed Ahmar Shah
- Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | - Colin R Simpson
- Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK; School of Health, Wellington Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | | | - Chris Robertson
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK; Public Health Scotland, Glasgow, UK
| | - Aziz Sheikh
- Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK; Asthma UK Centre for Applied Research, Usher Institute, University of Edinburgh, Edinburgh, UK.
| |
Collapse
|
33
|
Kerr S, Joy M, Torabi F, Bedston S, Akbari A, Agrawal U, Beggs J, Bradley D, Chuter A, Docherty AB, Ford D, Hobbs R, Katikireddi SV, Lowthian E, de Lusignan S, Lyons R, Marple J, McCowan C, McGagh D, McMenamin J, Moore E, Murray JLK, Owen RK, Pan J, Ritchie L, Shah SA, Shi T, Stock S, Tsang RSM, Vasileiou E, Woolhouse M, Simpson CR, Robertson C, Sheikh A. First dose ChAdOx1 and BNT162b2 COVID-19 vaccinations and cerebral venous sinus thrombosis: A pooled self-controlled case series study of 11.6 million individuals in England, Scotland, and Wales. PLoS Med 2022; 19:e1003927. [PMID: 35192598 PMCID: PMC8863261 DOI: 10.1371/journal.pmed.1003927] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 01/21/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Several countries restricted the administration of ChAdOx1 to older age groups in 2021 over safety concerns following case reports and observed versus expected analyses suggesting a possible association with cerebral venous sinus thrombosis (CVST). Large datasets are required to precisely estimate the association between Coronavirus Disease 2019 (COVID-19) vaccination and CVST due to the extreme rarity of this event. We aimed to accomplish this by combining national data from England, Scotland, and Wales. METHODS AND FINDINGS We created data platforms consisting of linked primary care, secondary care, mortality, and virological testing data in each of England, Scotland, and Wales, with a combined cohort of 11,637,157 people and 6,808,293 person years of follow-up. The cohort start date was December 8, 2020, and the end date was June 30, 2021. The outcome measure we examined was incident CVST events recorded in either primary or secondary care records. We carried out a self-controlled case series (SCCS) analysis of this outcome following first dose vaccination with ChAdOx1 and BNT162b2. The observation period consisted of an initial 90-day reference period, followed by a 2-week prerisk period directly prior to vaccination, and a 4-week risk period following vaccination. Counts of CVST cases from each country were tallied, then expanded into a full dataset with 1 row for each individual and observation time period. There was a combined total of 201 incident CVST events in the cohorts (29.5 per million person years). There were 81 CVST events in the observation period among those who a received first dose of ChAdOx1 (approximately 16.34 per million doses) and 40 for those who received a first dose of BNT162b2 (approximately 12.60 per million doses). We fitted conditional Poisson models to estimate incidence rate ratios (IRRs). Vaccination with ChAdOx1 was associated with an elevated risk of incident CVST events in the 28 days following vaccination, IRR = 1.93 (95% confidence interval (CI) 1.20 to 3.11). We did not find an association between BNT162b2 and CVST in the 28 days following vaccination, IRR = 0.78 (95% CI 0.34 to 1.77). Our study had some limitations. The SCCS study design implicitly controls for variables that are constant over the observation period, but also assumes that outcome events are independent of exposure. This assumption may not be satisfied in the case of CVST, firstly because it is a serious adverse event, and secondly because the vaccination programme in the United Kingdom prioritised the clinically extremely vulnerable and those with underlying health conditions, which may have caused a selection effect for individuals more prone to CVST. Although we pooled data from several large datasets, there was still a low number of events, which may have caused imprecision in our estimates. CONCLUSIONS In this study, we observed a small elevated risk of CVST events following vaccination with ChAdOx1, but not BNT162b2. Our analysis pooled information from large datasets from England, Scotland, and Wales. This evidence may be useful in risk-benefit analyses of vaccine policies and in providing quantification of risks associated with vaccination to the general public.
Collapse
Affiliation(s)
- Steven Kerr
- Usher Institute, The University of Edinburgh, Edinburgh, United Kingdom
| | - Mark Joy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Fatemeh Torabi
- Population Data Science, Swansea University Medical School, Swansea, United Kingdom
| | - Stuart Bedston
- Population Data Science, Swansea University Medical School, Swansea, United Kingdom
| | - Ashley Akbari
- Population Data Science, Swansea University Medical School, Swansea, United Kingdom
| | - Utkarsh Agrawal
- School of Medicine, University of St. Andrews, St Andrews, United Kingdom
| | - Jillian Beggs
- BREATHE–The Health Data Research Hub for Respiratory Health, University of Edinburgh, Edinburgh, United Kingdom
| | - Declan Bradley
- Queen’s University Belfast, Belfast, United Kingdom
- Public Health Agency, Belfast, United Kingdom
| | - Antony Chuter
- BREATHE–The Health Data Research Hub for Respiratory Health, University of Edinburgh, Edinburgh, United Kingdom
| | | | - David Ford
- Population Data Science, Swansea University Medical School, Swansea, United Kingdom
| | - Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | | | - Emily Lowthian
- Population Data Science, Swansea University Medical School, Swansea, United Kingdom
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Ronan Lyons
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - James Marple
- Royal Infirmary of Edinburgh, NHS Lothian and Anaesthesia, Critical Care and Pain Medicine, The University of Edinburgh, Edinburgh, United Kingdom
| | - Colin McCowan
- School of Medicine, University of St. Andrews, St Andrews, United Kingdom
| | - Dylan McGagh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | | | - Emily Moore
- Public Health Scotland, Glasgow, United Kingdom
| | | | - Rhiannon K. Owen
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Jiafeng Pan
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, United Kingdom
| | - Lewis Ritchie
- Academic Primary Care, University of Aberdeen School of Medicine and Dentistry, Aberdeen, United Kingdom
| | - Syed Ahmar Shah
- Usher Institute, The University of Edinburgh, Edinburgh, United Kingdom
| | - Ting Shi
- Usher Institute, The University of Edinburgh, Edinburgh, United Kingdom
| | - Sarah Stock
- Usher Institute, The University of Edinburgh, Edinburgh, United Kingdom
| | - Ruby S. M. Tsang
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | | | - Mark Woolhouse
- Usher Institute, The University of Edinburgh, Edinburgh, United Kingdom
| | - Colin R. Simpson
- Usher Institute, The University of Edinburgh, Edinburgh, United Kingdom
- School of Health, Wellington Faculty of Health, Victoria University of Wellington, New Zealand
| | - Chris Robertson
- Public Health Scotland, Glasgow, United Kingdom
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, United Kingdom
| | - Aziz Sheikh
- Usher Institute, The University of Edinburgh, Edinburgh, United Kingdom
| |
Collapse
|
34
|
Agrawal U, Katikireddi SV, McCowan C, Mulholland RH, Azcoaga-Lorenzo A, Amele S, Fagbamigbe AF, Vasileiou E, Grange Z, Shi T, Kerr S, Moore E, Murray JLK, Shah SA, Ritchie L, O'Reilly D, Stock SJ, Beggs J, Chuter A, Torabi F, Akbari A, Bedston S, McMenamin J, Wood R, Tang RSM, de Lusignan S, Hobbs FDR, Woolhouse M, Simpson CR, Robertson C, Sheikh A. COVID-19 hospital admissions and deaths after BNT162b2 and ChAdOx1 nCoV-19 vaccinations in 2·57 million people in Scotland (EAVE II): a prospective cohort study. Lancet Respir Med 2021; 9:1439-1449. [PMID: 34599903 PMCID: PMC8480963 DOI: 10.1016/s2213-2600(21)00380-5] [Citation(s) in RCA: 94] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 08/19/2021] [Accepted: 08/19/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The UK COVID-19 vaccination programme has prioritised vaccination of those at the highest risk of COVID-19 mortality and hospitalisation. The programme was rolled out in Scotland during winter 2020-21, when SARS-CoV-2 infection rates were at their highest since the pandemic started, despite social distancing measures being in place. We aimed to estimate the frequency of COVID-19 hospitalisation or death in people who received at least one vaccine dose and characterise these individuals. METHODS We conducted a prospective cohort study using the Early Pandemic Evaluation and Enhanced Surveillance of COVID-19 (EAVE II) national surveillance platform, which contained linked vaccination, primary care, RT-PCR testing, hospitalisation, and mortality records for 5·4 million people (around 99% of the population) in Scotland. Individuals were followed up from receiving their first dose of the BNT162b2 (Pfizer-BioNTech) or ChAdOx1 nCoV-19 (Oxford-AstraZeneca) COVID-19 vaccines until admission to hospital for COVID-19, death, or the end of the study period on April 18, 2021. We used a time-dependent Poisson regression model to estimate rate ratios (RRs) for demographic and clinical factors associated with COVID-19 hospitalisation or death 14 days or more after the first vaccine dose, stratified by vaccine type. FINDINGS Between Dec 8, 2020, and April 18, 2021, 2 572 008 individuals received their first dose of vaccine-841 090 (32·7%) received BNT162b2 and 1 730 918 (67·3%) received ChAdOx1. 1196 (<0·1%) individuals were admitted to hospital or died due to COVID-19 illness (883 hospitalised, of whom 228 died, and 313 who died due to COVID-19 without hospitalisation) 14 days or more after their first vaccine dose. These severe COVID-19 outcomes were associated with older age (≥80 years vs 18-64 years adjusted RR 4·75, 95% CI 3·85-5·87), comorbidities (five or more risk groups vs less than five risk groups 4·24, 3·34-5·39), hospitalisation in the previous 4 weeks (3·00, 2·47-3·65), high-risk occupations (ten or more previous COVID-19 tests vs less than ten previous COVID-19 tests 2·14, 1·62-2·81), care home residence (1·63, 1·32-2·02), socioeconomic deprivation (most deprived quintile vs least deprived quintile 1·57, 1·30-1·90), being male (1·27, 1·13-1·43), and being an ex-smoker (ex-smoker vs non-smoker 1·18, 1·01-1·38). A history of COVID-19 before vaccination was protective (0·40, 0·29-0·54). INTERPRETATION COVID-19 hospitalisations and deaths were uncommon 14 days or more after the first vaccine dose in this national analysis in the context of a high background incidence of SARS-CoV-2 infection and with extensive social distancing measures in place. Sociodemographic and clinical features known to increase the risk of severe disease in unvaccinated populations were also associated with severe outcomes in people receiving their first dose of vaccine and could help inform case management and future vaccine policy formulation. FUNDING UK Research and Innovation (Medical Research Council), Research and Innovation Industrial Strategy Challenge Fund, Scottish Government, and Health Data Research UK.
Collapse
Affiliation(s)
- Utkarsh Agrawal
- School of Medicine, University of St Andrews, St Andrews, UK
| | | | - Colin McCowan
- School of Medicine, University of St Andrews, St Andrews, UK
| | | | | | - Sarah Amele
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | | | | | | | - Ting Shi
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Steven Kerr
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | | | | | | | - Lewis Ritchie
- Academic Primary Care, University of Aberdeen School of Medicine and Dentistry, Aberdeen, UK
| | - Dermot O'Reilly
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, UK
| | - Sarah J Stock
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Jillian Beggs
- BREATHE-The Health Data Research Hub for Respiratory Health, Edinburgh, UK
| | - Antony Chuter
- BREATHE-The Health Data Research Hub for Respiratory Health, Edinburgh, UK
| | - Fatemah Torabi
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Ashley Akbari
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Stuart Bedston
- Population Data Science, Swansea University Medical School, Swansea, UK
| | | | - Rachael Wood
- Usher Institute, The University of Edinburgh, Edinburgh, UK; Public Health Scotland, Glasgow, UK
| | - Ruby S M Tang
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - F D Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Mark Woolhouse
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Colin R Simpson
- Usher Institute, The University of Edinburgh, Edinburgh, UK; School of Health, Wellington Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Chris Robertson
- Public Health Scotland, Glasgow, UK; Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - Aziz Sheikh
- Usher Institute, The University of Edinburgh, Edinburgh, UK.
| |
Collapse
|
35
|
Mueller T, Kerr S, McTaggart S, Kurdi A, Vasileiou E, Docherty A, Fraser K, Shi T, Simpson CR, Bennie M, Sheikh A. Retrospective cohort study to evaluate medication use in patients hospitalised with COVID-19 in Scotland: protocol for a national observational study. BMJ Open 2021; 11:e054861. [PMID: 34799365 PMCID: PMC8609490 DOI: 10.1136/bmjopen-2021-054861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 10/28/2021] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION COVID-19 has caused millions of hospitalisations and deaths globally. A range of vaccines have been developed and are being deployed at scale in the UK to prevent SARS-CoV-2 infection, which have reduced risk of infection and severe COVID-19 outcomes. Those with COVID-19 are now being treated with several repurposed drugs based on evidence emerging from recent clinical trials. However, there is currently limited real-world data available related to the use of these drugs in routine clinical practice. The purpose of this study is to address the prevailing knowledge gaps regarding the use of dexamethasone, remdesivir and tocilizumab by conducting an exploratory drug utilisation study, aimed at providing in-depth descriptions of patients receiving these drugs as well as the treatment patterns observed in Scotland. METHODS AND ANALYSIS Retrospective cohort study, comprising adult patients admitted to hospital with confirmed or suspected COVID-19 across five Scottish Health Boards using data from in-hospital ePrescribing linked to the Early Estimation of Vaccine and Anti-Viral Effectiveness (EAVE II) COVID-19 surveillance platform. The primary outcome will be exposure to the medicines of interest (dexamethasone, remdesivir, tocilizumab), either alone or in combination; exposure will be described in terms of drug(s) of choice; prescribed and administered dose; treatment duration; and any changes in treatment, for example, dose escalation and/or switching to an alternative drug. Analyses will primarily be descriptive in nature. ETHICS AND DISSEMINATION Ethical and information governance approvals have been obtained by the National Research Ethics Service Committee, South East Scotland 02 and the Public Benefit and Privacy Panel for Health and Social Care, respectively. Findings from this study will be presented at academic and clinical conferences, and to the funders and other interested parties as appropriate; study findings will also be published in peer-reviewed journals. Publications will be available on the EAVE II website (https://www.ed.ac.uk/usher/eave-ii/key-outputs/our-publications), alongside lay summaries and infographics aimed at the general public. Press releases will also be considered, if appropriate.
Collapse
Affiliation(s)
- Tanja Mueller
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
- Public Health Scotland Glasgow Office, Glasgow, UK
| | - Steven Kerr
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | | | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
- Public Health Scotland Glasgow Office, Glasgow, UK
| | | | | | | | - Ting Shi
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Colin R Simpson
- Usher Institute, The University of Edinburgh, Edinburgh, UK
- School of Health, Wellington Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Marion Bennie
- Public Health Scotland, Edinburgh, UK
- Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Aziz Sheikh
- Usher Institute, The University of Edinburgh, Edinburgh, UK
- BREATHE Hub, HDR UK, Edinburgh, UK
| |
Collapse
|
36
|
Evans RA, McAuley H, Harrison EM, Shikotra A, Singapuri A, Sereno M, Elneima O, Docherty AB, Lone NI, Leavy OC, Daines L, Baillie JK, Brown JS, Chalder T, De Soyza A, Diar Bakerly N, Easom N, Geddes JR, Greening NJ, Hart N, Heaney LG, Heller S, Howard L, Hurst JR, Jacob J, Jenkins RG, Jolley C, Kerr S, Kon OM, Lewis K, Lord JM, McCann GP, Neubauer S, Openshaw PJM, Parekh D, Pfeffer P, Rahman NM, Raman B, Richardson M, Rowland M, Semple MG, Shah AM, Singh SJ, Sheikh A, Thomas D, Toshner M, Chalmers JD, Ho LP, Horsley A, Marks M, Poinasamy K, Wain LV, Brightling CE. Physical, cognitive, and mental health impacts of COVID-19 after hospitalisation (PHOSP-COVID): a UK multicentre, prospective cohort study. Lancet Respir Med 2021; 9:1275-1287. [PMID: 34627560 PMCID: PMC8497028 DOI: 10.1016/s2213-2600(21)00383-0] [Citation(s) in RCA: 293] [Impact Index Per Article: 97.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 07/30/2021] [Accepted: 08/18/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND The impact of COVID-19 on physical and mental health and employment after hospitalisation with acute disease is not well understood. The aim of this study was to determine the effects of COVID-19-related hospitalisation on health and employment, to identify factors associated with recovery, and to describe recovery phenotypes. METHODS The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a multicentre, long-term follow-up study of adults (aged ≥18 years) discharged from hospital in the UK with a clinical diagnosis of COVID-19, involving an assessment between 2 and 7 months after discharge, including detailed recording of symptoms, and physiological and biochemical testing. Multivariable logistic regression was done for the primary outcome of patient-perceived recovery, with age, sex, ethnicity, body-mass index, comorbidities, and severity of acute illness as covariates. A post-hoc cluster analysis of outcomes for breathlessness, fatigue, mental health, cognitive impairment, and physical performance was done using the clustering large applications k-medoids approach. The study is registered on the ISRCTN Registry (ISRCTN10980107). FINDINGS We report findings for 1077 patients discharged from hospital between March 5 and Nov 30, 2020, who underwent assessment at a median of 5·9 months (IQR 4·9-6·5) after discharge. Participants had a mean age of 58 years (SD 13); 384 (36%) were female, 710 (69%) were of white ethnicity, 288 (27%) had received mechanical ventilation, and 540 (50%) had at least two comorbidities. At follow-up, only 239 (29%) of 830 participants felt fully recovered, 158 (20%) of 806 had a new disability (assessed by the Washington Group Short Set on Functioning), and 124 (19%) of 641 experienced a health-related change in occupation. Factors associated with not recovering were female sex, middle age (40-59 years), two or more comorbidities, and more severe acute illness. The magnitude of the persistent health burden was substantial but only weakly associated with the severity of acute illness. Four clusters were identified with different severities of mental and physical health impairment (n=767): very severe (131 patients, 17%), severe (159, 21%), moderate along with cognitive impairment (127, 17%), and mild (350, 46%). Of the outcomes used in the cluster analysis, all were closely related except for cognitive impairment. Three (3%) of 113 patients in the very severe cluster, nine (7%) of 129 in the severe cluster, 36 (36%) of 99 in the moderate cluster, and 114 (43%) of 267 in the mild cluster reported feeling fully recovered. Persistently elevated serum C-reactive protein was positively associated with cluster severity. INTERPRETATION We identified factors related to not recovering after hospital admission with COVID-19 at 6 months after discharge (eg, female sex, middle age, two or more comorbidities, and more acute severe illness), and four different recovery phenotypes. The severity of physical and mental health impairments were closely related, whereas cognitive health impairments were independent. In clinical care, a proactive approach is needed across the acute severity spectrum, with interdisciplinary working, wide access to COVID-19 holistic clinical services, and the potential to stratify care. FUNDING UK Research and Innovation and National Institute for Health Research.
Collapse
Affiliation(s)
- Rachael A Evans
- Institute for Lung Health, Leicester NIHR Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Hamish McAuley
- Institute for Lung Health, Leicester NIHR Biomedical Research Centre, University of Leicester, Leicester, UK
| | | | - Aarti Shikotra
- Institute for Lung Health, Leicester NIHR Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Amisha Singapuri
- Institute for Lung Health, Leicester NIHR Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Marco Sereno
- Institute for Lung Health, Leicester NIHR Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Omer Elneima
- Institute for Lung Health, Leicester NIHR Biomedical Research Centre, University of Leicester, Leicester, UK
| | | | - Nazir I Lone
- Usher Institute, University of Edinburgh, Edinburgh, UK; Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | - Olivia C Leavy
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Luke Daines
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - J Kenneth Baillie
- Roslin Institute, University of Edinburgh, Edinburgh, UK; Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | - Jeremy S Brown
- UCL Respiratory, Department of Medicine, University College London, London, UK
| | - Trudie Chalder
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Anthony De Soyza
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK; Newcastle upon Tyne Teaching Hospitals Trust, Newcastle upon Tyne, UK
| | - Nawar Diar Bakerly
- Manchester Metropolitan University, Manchester, UK; Salford Royal NHS Foundation Trust, Manchester, UK
| | - Nicholas Easom
- Infection Research Group, Hull University Teaching Hospitals, Hull, UK
| | - John R Geddes
- NIHR Oxford Health Biomedical Research Centre, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK
| | - Neil J Greening
- Institute for Lung Health, Leicester NIHR Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Nick Hart
- Lane Fox Respiratory Service, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Liam G Heaney
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK; Belfast Health & Social Care Trust, Belfast, UK
| | - Simon Heller
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Luke Howard
- Imperial College Healthcare NHS Trust, London, UK, University College London, London, UK
| | - John R Hurst
- UCL Respiratory, Department of Medicine, University College London, London, UK
| | - Joseph Jacob
- Centre for Medical Image Computing, University College London, London, UK; Lungs for Living Research Centre, University College London, London, UK
| | - R Gisli Jenkins
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Caroline Jolley
- Centre for Human and Applied Physiological Sciences, School of Basic and Medical Biosciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Steven Kerr
- Roslin Institute, University of Edinburgh, Edinburgh, UK
| | - Onn M Kon
- Imperial College Healthcare NHS Trust, London, UK, University College London, London, UK; National Heart and Lung Institute, Imperial College London, London, UK
| | - Keir Lewis
- Hywel Dda University Health Board, Wales, UK; University of Swansea, Swansea, UK; Respiratory Innovation Wales, Llanelli, UK
| | - Janet M Lord
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Gerry P McCann
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK; Leicester NIHR Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Stefan Neubauer
- NIHR Oxford Health Biomedical Research Centre, University of Oxford, Oxford, UK; Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | | | - Dhruv Parekh
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK; Department of Acute Medicine, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Paul Pfeffer
- Barts Health NHS Trust, London, UK; Queen Mary University of London, London, UK
| | - Najib M Rahman
- Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK
| | - Betty Raman
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Matthew Richardson
- Institute for Lung Health, Leicester NIHR Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Matthew Rowland
- Kadoorie Centre for Critical Care Research, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Malcolm G Semple
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, UK; Respiratory Medicine, Alder Hey Children's Hospital, Liverpool, UK
| | - Ajay M Shah
- King's College London British Heart Foundation Centre and King's College Hospital NHS Foundation Trust, London, UK
| | - Sally J Singh
- Institute for Lung Health, Leicester NIHR Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Aziz Sheikh
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - David Thomas
- Immunology and Inflammation, Imperial College London, London, UK
| | - Mark Toshner
- Cambridge NIHR Biomedical Research Centre, Cambridge, UK; NIHR Cambridge Clinical Research Facility, Cambridge, UK
| | - James D Chalmers
- University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Ling-Pei Ho
- MRC Human Immunology Unit, University of Oxford, Oxford, UK
| | - Alex Horsley
- Division of Infection, Immunity & Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Michael Marks
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK; Hospital for Tropical Diseases, University College London Hospital, London, UK
| | | | - Louise V Wain
- Institute for Lung Health, Leicester NIHR Biomedical Research Centre, University of Leicester, Leicester, UK; Department of Health Sciences, University of Leicester, Leicester, UK
| | - Christopher E Brightling
- Institute for Lung Health, Leicester NIHR Biomedical Research Centre, University of Leicester, Leicester, UK.
| |
Collapse
|
37
|
Henery P, Vasileiou E, Hainey KJ, Buchanan D, Harrison E, Leyland AH, Alexis T, Robertson C, Agrawal U, Ritchie L, Stock SJ, McCowan C, Docherty A, Kerr S, Marple J, Wood R, Moore E, Simpson CR, Sheikh A, Katikireddi SV. Ethnic and social inequalities in COVID-19 outcomes in Scotland: protocol for early pandemic evaluation and enhanced surveillance of COVID-19 (EAVE II). BMJ Open 2021; 11:e048852. [PMID: 34376451 PMCID: PMC8359861 DOI: 10.1136/bmjopen-2021-048852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Evidence from previous pandemics, and the current COVID-19 pandemic, has found that risk of infection/severity of disease is disproportionately higher for ethnic minority groups, and those in lower socioeconomic positions. It is imperative that interventions to prevent the spread of COVID-19 are targeted towards high-risk populations. We will investigate the associations between social characteristics (such as ethnicity, occupation and socioeconomic position) and COVID-19 outcomes and the extent to which characteristics/risk factors might explain observed relationships in Scotland.The primary objective of this study is to describe the epidemiology of COVID-19 by social factors. Secondary objectives are to (1) examine receipt of treatment and prevention of COVID-19 by social factors; (2) quantify ethnic/social differences in adverse COVID-19 outcomes; (3) explore potential mediators of relationships between social factors and SARS-CoV-2 infection/COVID-19 prognosis; (4) examine whether occupational COVID-19 differences differ by other social factors and (5) assess quality of ethnicity coding within National Health Service datasets. METHODS AND ANALYSIS We will use a national cohort comprising the adult population of Scotland who completed the 2011 Census and were living in Scotland on 31 March 2020 (~4.3 million people). Census data will be linked to the Early Assessment of Vaccine and Anti-Viral Effectiveness II cohort consisting of primary/secondary care, laboratory data and death records. Sensitivity/specificity and positive/negative predictive values will be used to assess coding quality of ethnicity. Descriptive statistics will be used to examine differences in treatment and prevention of COVID-19. Poisson/Cox regression analyses and mediation techniques will examine ethnic and social differences, and drivers of inequalities in COVID-19. Effect modification (on additive and multiplicative scales) between key variables (such as ethnicity and occupation) will be assessed. ETHICS AND DISSEMINATION Ethical approval was obtained from the National Research Ethics Committee, South East Scotland 02. We will present findings of this study at international conferences, in peer-reviewed journals and to policy-makers.
Collapse
Affiliation(s)
- Paul Henery
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
- Public Health Scotland, Edinburgh, UK
| | | | - Kirsten J Hainey
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | | | - Ewen Harrison
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Alastair H Leyland
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | | | - Chris Robertson
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - Utkarsh Agrawal
- School of Medicine, University of St Andrews, St Andrews, Fife, UK
| | - Lewis Ritchie
- General Practice and Primary Care, Aberdeen University, Aberdeen, UK
| | - Sarah Jane Stock
- Public Health Scotland, Edinburgh, UK
- Centre for Medical Informatics, The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
| | - Colin McCowan
- School of Medicine, University of St. Andrews, St. Andrews, UK
| | | | - Steven Kerr
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - James Marple
- Division of Community Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Rachael Wood
- Usher Institute, The University of Edinburgh, Edinburgh, UK
- Information Services Division, NHS National Services Scotland, Edinburgh, UK
| | | | - Colin R Simpson
- Usher Institute, The University of Edinburgh, Edinburgh, UK
- Wellington Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Aziz Sheikh
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Srinivasa Vittal Katikireddi
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
- Public Health Scotland, Edinburgh, UK
| |
Collapse
|
38
|
Nguala S, Beltremieux G, Salaun-Penquer N, Kerr S, Schemoul J, Raffetin A. Étude du rapport coût–efficacité d’une prise en charge pluridisciplinaire des suspicions de borréliose de Lyme. Infect Dis Now 2021. [DOI: 10.1016/j.idnow.2021.06.298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
39
|
Rusby DR, King PM, Pak A, Lemos N, Kerr S, Cochran G, Pagano I, Hannasch A, Quevedo H, Spinks M, Donovan M, Link A, Kemp A, Wilks SC, Williams GJ, Manuel MJE, Gavin Z, Haid A, Albert F, Aufderheide M, Chen H, Siders CW, Macphee A, Mackinnon A. Enhancements in laser-generated hot-electron production via focusing cone targets at short pulse and high contrast. Phys Rev E 2021; 103:053207. [PMID: 34134339 DOI: 10.1103/physreve.103.053207] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 03/31/2021] [Indexed: 11/07/2022]
Abstract
We report on the increase in the accelerated electron number and energy using compound parabolic concentrator (CPC) targets from a short-pulse (∼150 fs), high-intensity (>10^{18} W/cm^{2}), and high-contrast (∼10^{8}) laser-solid interaction. We report on experimental measurements using CPC targets where the hot-electron temperature is enhanced up to ∼9 times when compared to planar targets. The temperature measured from the CPC target is 〈T_{e}〉=4.4±1.3 MeV. Using hydrodynamic and particle in cell simulations, we identify the primary source of this temperature enhancement is the intensity increase caused by the CPC geometry that focuses the laser, reducing the focal spot and therefore increasing the intensity of the laser-solid interaction, which is also consistent with analytic expectations for the geometrical focusing.
Collapse
Affiliation(s)
- D R Rusby
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - P M King
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA.,Department of Physics, University of Texas at Austin, Austin, Texas 78712, USA
| | - A Pak
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - N Lemos
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - S Kerr
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - G Cochran
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - I Pagano
- Department of Physics, University of Texas at Austin, Austin, Texas 78712, USA
| | - A Hannasch
- Department of Physics, University of Texas at Austin, Austin, Texas 78712, USA
| | - H Quevedo
- Department of Physics, University of Texas at Austin, Austin, Texas 78712, USA
| | - M Spinks
- Department of Physics, University of Texas at Austin, Austin, Texas 78712, USA
| | - M Donovan
- Department of Physics, University of Texas at Austin, Austin, Texas 78712, USA
| | - A Link
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - A Kemp
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - S C Wilks
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - G J Williams
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - M J-E Manuel
- General Atomics, 3550 General Atomics Ave, San Diego, California 92103, USA
| | - Z Gavin
- General Atomics, 3550 General Atomics Ave, San Diego, California 92103, USA
| | - A Haid
- General Atomics, 3550 General Atomics Ave, San Diego, California 92103, USA
| | - F Albert
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - M Aufderheide
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - H Chen
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - C W Siders
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - A Macphee
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - A Mackinnon
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| |
Collapse
|
40
|
Vasileiou E, Simpson CR, Shi T, Kerr S, Agrawal U, Akbari A, Bedston S, Beggs J, Bradley D, Chuter A, de Lusignan S, Docherty AB, Ford D, Hobbs FR, Joy M, Katikireddi SV, Marple J, McCowan C, McGagh D, McMenamin J, Moore E, Murray JL, Pan J, Ritchie L, Shah SA, Stock S, Torabi F, Tsang RS, Wood R, Woolhouse M, Robertson C, Sheikh A. Interim findings from first-dose mass COVID-19 vaccination roll-out and COVID-19 hospital admissions in Scotland: a national prospective cohort study. Lancet 2021. [PMID: 33901420 DOI: 10.1016/s0140-6734(21)00677-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
BACKGROUND The BNT162b2 mRNA (Pfizer-BioNTech) and ChAdOx1 nCoV-19 (Oxford-AstraZeneca) COVID-19 vaccines have shown high efficacy against disease in phase 3 clinical trials and are now being used in national vaccination programmes in the UK and several other countries. Studying the real-world effects of these vaccines is an urgent requirement. The aim of our study was to investigate the association between the mass roll-out of the first doses of these COVID-19 vaccines and hospital admissions for COVID-19. METHODS We did a prospective cohort study using the Early Pandemic Evaluation and Enhanced Surveillance of COVID-19-EAVE II-database comprising linked vaccination, primary care, real-time reverse transcription-PCR testing, and hospital admission patient records for 5·4 million people in Scotland (about 99% of the population) registered at 940 general practices. Individuals who had previously tested positive were excluded from the analysis. A time-dependent Cox model and Poisson regression models with inverse propensity weights were fitted to estimate effectiveness against COVID-19 hospital admission (defined as 1-adjusted rate ratio) following the first dose of vaccine. FINDINGS Between Dec 8, 2020, and Feb 22, 2021, a total of 1 331 993 people were vaccinated over the study period. The mean age of those vaccinated was 65·0 years (SD 16·2). The first dose of the BNT162b2 mRNA vaccine was associated with a vaccine effect of 91% (95% CI 85-94) for reduced COVID-19 hospital admission at 28-34 days post-vaccination. Vaccine effect at the same time interval for the ChAdOx1 vaccine was 88% (95% CI 75-94). Results of combined vaccine effects against hospital admission due to COVID-19 were similar when restricting the analysis to those aged 80 years and older (83%, 95% CI 72-89 at 28-34 days post-vaccination). INTERPRETATION Mass roll-out of the first doses of the BNT162b2 mRNA and ChAdOx1 vaccines was associated with substantial reductions in the risk of hospital admission due to COVID-19 in Scotland. There remains the possibility that some of the observed effects might have been due to residual confounding. FUNDING UK Research and Innovation (Medical Research Council), Research and Innovation Industrial Strategy Challenge Fund, Health Data Research UK.
Collapse
Affiliation(s)
| | - Colin R Simpson
- Usher Institute, The University of Edinburgh, Edinburgh, UK; School of Health, Wellington Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Ting Shi
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Steven Kerr
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Utkarsh Agrawal
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Ashley Akbari
- Population Data Science, Swansea University Medical School, Swansea University, Swansea, UK
| | - Stuart Bedston
- Population Data Science, Swansea University Medical School, Swansea University, Swansea, UK
| | - Jillian Beggs
- The Health Data Research Hub for Respiratory Health, Edinburgh, UK
| | - Declan Bradley
- Public Health Agency, Belfast, UK; Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Antony Chuter
- Usher Institute, The University of Edinburgh, Edinburgh, UK; The Health Data Research Hub for Respiratory Health, Edinburgh, UK
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - David Ford
- Health Informatics, Health Informatics Group, College of Medicine, Swansea University, Swansea, UK
| | - Fd Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Mark Joy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - James Marple
- Royal Infirmary of Edinburgh, NHS Lothian and Anaesthesia, Critical Care and Pain Medicine, The University of Edinburgh, Edinburgh, UK
| | - Colin McCowan
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Dylan McGagh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | | | | | - Jiafeng Pan
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - Lewis Ritchie
- Academic Primary Care, University of Aberdeen School of Medicine and Dentistry, Aberdeen, UK
| | | | - Sarah Stock
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Fatemeh Torabi
- Population Data Science, Swansea University Medical School, Swansea University, Swansea, UK
| | - Ruby Sm Tsang
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Rachael Wood
- Clinical and Public Health Intelligence team, Public Health Scotland, Edinburgh, UK
| | - Mark Woolhouse
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Chris Robertson
- Public Health Scotland, Glasgow UK; Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - Aziz Sheikh
- Usher Institute, The University of Edinburgh, Edinburgh, UK.
| |
Collapse
|
41
|
Vasileiou E, Simpson CR, Shi T, Kerr S, Agrawal U, Akbari A, Bedston S, Beggs J, Bradley D, Chuter A, de Lusignan S, Docherty AB, Ford D, Hobbs FR, Joy M, Katikireddi SV, Marple J, McCowan C, McGagh D, McMenamin J, Moore E, Murray JL, Pan J, Ritchie L, Shah SA, Stock S, Torabi F, Tsang RS, Wood R, Woolhouse M, Robertson C, Sheikh A. Interim findings from first-dose mass COVID-19 vaccination roll-out and COVID-19 hospital admissions in Scotland: a national prospective cohort study. Lancet 2021; 397:1646-1657. [PMID: 33901420 PMCID: PMC8064669 DOI: 10.1016/s0140-6736(21)00677-2] [Citation(s) in RCA: 376] [Impact Index Per Article: 125.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/12/2021] [Accepted: 03/17/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND The BNT162b2 mRNA (Pfizer-BioNTech) and ChAdOx1 nCoV-19 (Oxford-AstraZeneca) COVID-19 vaccines have shown high efficacy against disease in phase 3 clinical trials and are now being used in national vaccination programmes in the UK and several other countries. Studying the real-world effects of these vaccines is an urgent requirement. The aim of our study was to investigate the association between the mass roll-out of the first doses of these COVID-19 vaccines and hospital admissions for COVID-19. METHODS We did a prospective cohort study using the Early Pandemic Evaluation and Enhanced Surveillance of COVID-19-EAVE II-database comprising linked vaccination, primary care, real-time reverse transcription-PCR testing, and hospital admission patient records for 5·4 million people in Scotland (about 99% of the population) registered at 940 general practices. Individuals who had previously tested positive were excluded from the analysis. A time-dependent Cox model and Poisson regression models with inverse propensity weights were fitted to estimate effectiveness against COVID-19 hospital admission (defined as 1-adjusted rate ratio) following the first dose of vaccine. FINDINGS Between Dec 8, 2020, and Feb 22, 2021, a total of 1 331 993 people were vaccinated over the study period. The mean age of those vaccinated was 65·0 years (SD 16·2). The first dose of the BNT162b2 mRNA vaccine was associated with a vaccine effect of 91% (95% CI 85-94) for reduced COVID-19 hospital admission at 28-34 days post-vaccination. Vaccine effect at the same time interval for the ChAdOx1 vaccine was 88% (95% CI 75-94). Results of combined vaccine effects against hospital admission due to COVID-19 were similar when restricting the analysis to those aged 80 years and older (83%, 95% CI 72-89 at 28-34 days post-vaccination). INTERPRETATION Mass roll-out of the first doses of the BNT162b2 mRNA and ChAdOx1 vaccines was associated with substantial reductions in the risk of hospital admission due to COVID-19 in Scotland. There remains the possibility that some of the observed effects might have been due to residual confounding. FUNDING UK Research and Innovation (Medical Research Council), Research and Innovation Industrial Strategy Challenge Fund, Health Data Research UK.
Collapse
Affiliation(s)
| | - Colin R Simpson
- Usher Institute, The University of Edinburgh, Edinburgh, UK; School of Health, Wellington Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Ting Shi
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Steven Kerr
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Utkarsh Agrawal
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Ashley Akbari
- Population Data Science, Swansea University Medical School, Swansea University, Swansea, UK
| | - Stuart Bedston
- Population Data Science, Swansea University Medical School, Swansea University, Swansea, UK
| | - Jillian Beggs
- The Health Data Research Hub for Respiratory Health, Edinburgh, UK
| | - Declan Bradley
- Public Health Agency, Belfast, UK; Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Antony Chuter
- Usher Institute, The University of Edinburgh, Edinburgh, UK; The Health Data Research Hub for Respiratory Health, Edinburgh, UK
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - David Ford
- Health Informatics, Health Informatics Group, College of Medicine, Swansea University, Swansea, UK
| | - Fd Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Mark Joy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - James Marple
- Royal Infirmary of Edinburgh, NHS Lothian and Anaesthesia, Critical Care and Pain Medicine, The University of Edinburgh, Edinburgh, UK
| | - Colin McCowan
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Dylan McGagh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | | | | | - Jiafeng Pan
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - Lewis Ritchie
- Academic Primary Care, University of Aberdeen School of Medicine and Dentistry, Aberdeen, UK
| | | | - Sarah Stock
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Fatemeh Torabi
- Population Data Science, Swansea University Medical School, Swansea University, Swansea, UK
| | - Ruby Sm Tsang
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Rachael Wood
- Clinical and Public Health Intelligence team, Public Health Scotland, Edinburgh, UK
| | - Mark Woolhouse
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Chris Robertson
- Public Health Scotland, Glasgow UK; Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - Aziz Sheikh
- Usher Institute, The University of Edinburgh, Edinburgh, UK.
| |
Collapse
|
42
|
Jeet J, Eckart M, Gjemso J, Hahn K, Hartouni EP, Kerr S, Mariscal E, Moore AS, Rubery M, Schlossberg DJ. Proof-of-concept of a neutron time-of-flight ellipsoidal detector. Rev Sci Instrum 2021; 92:043555. [PMID: 34243390 DOI: 10.1063/5.0043829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 04/03/2021] [Indexed: 06/13/2023]
Abstract
The time-resolved measurement of neutrons emitted from nuclear implosions at inertial confinement fusion facilities is used to characterize the fusing plasma. Several significant quantities are routinely measured by neutron time-of-flight (nToF) detectors in these experiments. Current nToF detectors use scintillators as well as solid-state Cherenkov radiators. The latter has an inherently faster time response and can provide a co-registered γ-ray measurement as well as improved precision in the bulk hot-spot velocity. This work discusses a nToF ellipsoidal detector that also utilizes a solid-state Cherenkov radiator. The detector has the potential to achieve a fast instrument response function allowing for characterization of the γ-ray burn history as well as the ability to field the detector closer to the fusion source. Proof-of-concept testing of the nToF ellipsoidal detector has been conducted at the National Ignition Facility using commercial optics. A time-resolved neutron signal has been measured from the diagnostic. Preliminary simulations corroborate the results.
Collapse
Affiliation(s)
- J Jeet
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - M Eckart
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - J Gjemso
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - K Hahn
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - E P Hartouni
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - S Kerr
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - E Mariscal
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - A S Moore
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - M Rubery
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - D J Schlossberg
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| |
Collapse
|
43
|
Kerr S, Crawford AH, De Decker S. Late onset recurrence of clinical signs after surgery for intervertebral disc extrusion in French bulldogs. J Small Anim Pract 2021; 62:683-689. [PMID: 33769576 DOI: 10.1111/jsap.13331] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 01/25/2021] [Accepted: 03/04/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To identify the prevalence of recurrence of clinical signs after initial successful decompressive surgery for intervertebral disc extrusion in French bulldogs. MATERIALS AND METHODS A medical record search was performed to identify French bulldogs that experienced an initial successful outcome after surgery for thoracolumbar or cervical intervertebral disc extrusion. Collected information included signalment, neurological examination findings, intervertebral disc extrusion location, presence of vertebral malformations, kyphosis, type and extent of surgery. Decompressive surgery was not followed by extensive prophylactic fenestrations. Follow-up information was retrieved from medical records and telephone interviews with referring veterinary surgeons. RESULTS Eighty-four French bulldogs with thoracolumbar (n=55) or cervical (n=29) intervertebral disc extrusion were included. Forty-three (51%) dogs that had decompressive surgery for thoracolumbar (n=29) or cervical (n=14) intervertebral disc extrusion suffered recurrence of signs. The median time between decompressive surgery and recurrence of clinical signs was 9 months and 21 days. Of the 29 dogs suffering recurrence of clinical signs following surgery for thoracolumbar intervertebral disc extrusion, 24 returned for recurrence of clinical signs localised to the thoracolumbar segments, while five returned for recurrence of signs localised to the cervical region. Of the 14 dogs who suffered recurrence of signs following surgery for cervical intervertebral disc extrusion, nine returned for signs localised to the cervical region, while five returned for clinical signs localised to the thoracolumbar region. CLINICAL SIGNIFICANCE This study suggests a high rate of late onset recurrence of clinical signs after decompressive surgery for intervertebral disc extrusion in French bulldogs. This information can aid in the management of owner expectations.
Collapse
Affiliation(s)
- S Kerr
- Royal Veterinary College, University of London, Hatfield, UK
| | - A H Crawford
- Royal Veterinary College, University of London, Hatfield, UK
| | - S De Decker
- Royal Veterinary College, University of London, Hatfield, UK
| |
Collapse
|
44
|
Wall K, Kerr S, Nguyen M, Sharp C. The relation between measures of explicit shame and borderline personality features in adolescent inpatients. J Affect Disord 2021; 282:458-464. [PMID: 33422823 DOI: 10.1016/j.jad.2020.12.152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 11/10/2020] [Accepted: 12/23/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Shame is a highly negative emotion frequently experienced by individuals with borderline personality disorder (BPD) as well as those with internalizing or externalizing psychopathology. However, few studies have examined whether shame is related to BPD above and beyond other psychopathology. Further, although feelings of shame peak during adolescence, coinciding with the onset of BPD, very few studies have examined the relationship between shame and BPD in adolescence. Therefore, the current study examined (1) whether levels of shame differ between adolescent psychiatric inpatients with and without BPD and (2) whether borderline personality pathology accounts for additional variance in the experience of shame above and beyond internalizing and externalizing psychopathology. METHODS Adolescent psychiatric inpatients (n = 184, 67% female, M age = 15.26) completed clinical interviews and self-report measures as well as self-report measures of three types of explicit shame: state-shame, shame-proneness, and trait-shame. RESULTS T-tests revealed that adolescents with BPD reported significantly higher levels of each type of explicit shame. In hierarchical regression models, borderline personality features explained significant additional variance in shame-proneness and trait-shame while controlling for age, gender, and internalizing and externalizing psychopathology. LIMITATIONS Our sample was limited by a lack of demographic diversity and healthy control group, and the study did not examine relations with unique internalizing/externalizing disorders or features of BPD. CONCLUSIONS Our findings contribute to growing evidence that shame is an important component of BPD, particularly during adolescence, and suggest that shame should be addressed in treatment.
Collapse
Affiliation(s)
- K Wall
- University of Houston, Department of Psychology, 3695 Cullen Blvd, Room 126, Houston, TX, United States
| | - S Kerr
- University of Houston, Department of Psychology, 3695 Cullen Blvd, Room 126, Houston, TX, United States
| | - M Nguyen
- University of Houston, Department of Psychology, 3695 Cullen Blvd, Room 126, Houston, TX, United States
| | - C Sharp
- University of Houston, Department of Psychology, 3695 Cullen Blvd, Room 126, Houston, TX, United States.
| |
Collapse
|
45
|
Low S, Wu H, Jerath K, Tibolla A, Fogal B, Conrad R, MacDougall M, Kerr S, Berger V, Dave R, Villalona J, Pantages L, Ahlberg J, Li H, Van Hoorick D, Ververken C, Broadwater J, Waterman A, Singh S, Kroe-Barrett R. VHH antibody targeting the chemokine receptor CX3CR1 inhibits progression of atherosclerosis. MAbs 2021; 12:1709322. [PMID: 31924119 PMCID: PMC6973309 DOI: 10.1080/19420862.2019.1709322] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
CX3CR1 has been identified as a highly attractive target for several therapeutic interventions. Despite this potential, no potent antagonists, either small molecule or monoclonal antibody, have been identified. Here we describe the lead finding and engineering approach that lead to the identification of BI 655088, a potent biotherapeutic antagonist to CX3CR1. BI 655088 is a potent CX3CR1 antagonist that, upon therapeutic dosing, significantly inhibits plaque progression in the standard mouse model of atherosclerosis. BI 655088 represents a novel and highly selective biotherapeutic that could reduce inflammation in the atherosclerotic plaque when added to standard of care treatment including statins, which could result in a significant decrease in atherothrombotic events in patients with existing cardiovascular disease.
Collapse
Affiliation(s)
- Sarah Low
- Biotherapeutics Molecule Discovery, Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, CT, USA
| | - Haixia Wu
- Biotherapeutics Molecule Discovery, Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, CT, USA
| | - Kavita Jerath
- Biotherapeutics Molecule Discovery, Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, CT, USA
| | - Annette Tibolla
- Cardiometabolic Disease Research, Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, CT, USA
| | - Birgit Fogal
- Cardiometabolic Disease Research, Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, CT, USA
| | - Rebecca Conrad
- Cardiometabolic Disease Research, Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, CT, USA
| | - Margit MacDougall
- Cardiometabolic Disease Research, Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, CT, USA
| | - Steven Kerr
- Cardiometabolic Disease Research, Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, CT, USA
| | - Valentina Berger
- Cardiometabolic Disease Research, Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, CT, USA
| | - Rajvee Dave
- Cardiometabolic Disease Research, Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, CT, USA
| | - Jorge Villalona
- Cardiometabolic Disease Research, Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, CT, USA
| | - Lynn Pantages
- Cardiometabolic Disease Research, Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, CT, USA
| | - Jennifer Ahlberg
- Biotherapeutics Pharmacokinetics, Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, CT, USA
| | - Hua Li
- Biotherapeutics Pharmacokinetics, Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, CT, USA
| | | | - Cedric Ververken
- Project Management, Ablynx a Sanofi Company, Zwijnaarde, Belgium
| | - John Broadwater
- Cardiometabolic Disease Research, Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, CT, USA
| | - Alisa Waterman
- Cardiometabolic Disease Research, Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, CT, USA
| | - Sanjaya Singh
- Biotherapeutics Molecule Discovery, Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, CT, USA
| | - Rachel Kroe-Barrett
- Biotherapeutics Molecule Discovery, Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, CT, USA
| |
Collapse
|
46
|
Moore AS, Hartouni EP, Schlossberg D, Kerr S, Eckart M, Carrera J, Ma L, Waltz C, Barker D, Gjemso J, Mariscal E, Grim G, Kilkenny J. The five line-of-sight neutron time-of-flight (nToF) suite on the National Ignition Facility (NIF). Rev Sci Instrum 2021; 92:023516. [PMID: 33648072 DOI: 10.1063/5.0040730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 02/01/2021] [Indexed: 06/12/2023]
Abstract
Measurement of the neutron spectrum from inertial confinement fusion implosions is one of the primary diagnostics of implosion performance. Analysis of the spectrum gives access to quantities such as neutron yield, hot-spot velocity, apparent ion temperature, and compressed fuel ρr through measurement of the down-scatter ratio. On the National Ignition Facility, the neutron time-of-flight suite has been upgraded to include five independent, collimated lines of sight, each comprising a high dynamic range bibenzyl/diphenylacetylene-stilbene scintillator [R. Hatarik et al., Plasma Fusion Res. 9, 4404104 (2014)] and high-speed fused silica Cherenkov detectors [A. S. Moore et al., Rev. Sci. Instrum. 89, 10I120 (2018)].
Collapse
Affiliation(s)
- A S Moore
- Lawrence Livermore National Laboratory, P.O. Box 808, Livermore, California 94551-0808, USA
| | - E P Hartouni
- Lawrence Livermore National Laboratory, P.O. Box 808, Livermore, California 94551-0808, USA
| | - D Schlossberg
- Lawrence Livermore National Laboratory, P.O. Box 808, Livermore, California 94551-0808, USA
| | - S Kerr
- Lawrence Livermore National Laboratory, P.O. Box 808, Livermore, California 94551-0808, USA
| | - M Eckart
- Lawrence Livermore National Laboratory, P.O. Box 808, Livermore, California 94551-0808, USA
| | - J Carrera
- Lawrence Livermore National Laboratory, P.O. Box 808, Livermore, California 94551-0808, USA
| | - L Ma
- Lawrence Livermore National Laboratory, P.O. Box 808, Livermore, California 94551-0808, USA
| | - C Waltz
- Lawrence Livermore National Laboratory, P.O. Box 808, Livermore, California 94551-0808, USA
| | - D Barker
- Lawrence Livermore National Laboratory, P.O. Box 808, Livermore, California 94551-0808, USA
| | - J Gjemso
- Lawrence Livermore National Laboratory, P.O. Box 808, Livermore, California 94551-0808, USA
| | - E Mariscal
- Lawrence Livermore National Laboratory, P.O. Box 808, Livermore, California 94551-0808, USA
| | - G Grim
- Lawrence Livermore National Laboratory, P.O. Box 808, Livermore, California 94551-0808, USA
| | - J Kilkenny
- General Atomics, San Diego, California 92121, USA
| |
Collapse
|
47
|
Simpson CR, Shi T, Vasileiou E, Katikireddi SV, Kerr S, Moore E, McCowan C, Agrawal U, Shah SA, Ritchie LD, Murray J, Pan J, Bradley DT, Stock SJ, Wood R, Chuter A, Beggs J, Stagg HR, Joy M, Tsang RSM, de Lusignan S, Hobbs R, Lyons RA, Torabi F, Bedston S, O’Leary M, Akbari A, McMenamin J, Robertson C, Sheikh A. First-dose ChAdOx1 and BNT162b2 COVID-19 vaccines and thrombocytopenic, thromboembolic and hemorrhagic events in Scotland. Nat Med 2021; 27:1290-1297. [PMID: 34108714 PMCID: PMC8282499 DOI: 10.1038/s41591-021-01408-4] [Citation(s) in RCA: 172] [Impact Index Per Article: 57.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 05/26/2021] [Indexed: 02/04/2023]
Abstract
Reports of ChAdOx1 vaccine-associated thrombocytopenia and vascular adverse events have led to some countries restricting its use. Using a national prospective cohort, we estimated associations between exposure to first-dose ChAdOx1 or BNT162b2 vaccination and hematological and vascular adverse events using a nested incident-matched case-control study and a confirmatory self-controlled case series (SCCS) analysis. An association was found between ChAdOx1 vaccination and idiopathic thrombocytopenic purpura (ITP) (0-27 d after vaccination; adjusted rate ratio (aRR) = 5.77, 95% confidence interval (CI), 2.41-13.83), with an estimated incidence of 1.13 (0.62-1.63) cases per 100,000 doses. An SCCS analysis confirmed that this was unlikely due to bias (RR = 1.98 (1.29-3.02)). There was also an increased risk for arterial thromboembolic events (aRR = 1.22, 1.12-1.34) 0-27 d after vaccination, with an SCCS RR of 0.97 (0.93-1.02). For hemorrhagic events 0-27 d after vaccination, the aRR was 1.48 (1.12-1.96), with an SCCS RR of 0.95 (0.82-1.11). A first dose of ChAdOx1 was found to be associated with small increased risks of ITP, with suggestive evidence of an increased risk of arterial thromboembolic and hemorrhagic events. The attenuation of effect found in the SCCS analysis means that there is the potential for overestimation of the reported results, which might indicate the presence of some residual confounding or confounding by indication. Public health authorities should inform their jurisdictions of these relatively small increased risks associated with ChAdOx1. No positive associations were seen between BNT162b2 and thrombocytopenic, thromboembolic and hemorrhagic events.
Collapse
Affiliation(s)
- C. R. Simpson
- grid.267827.e0000 0001 2292 3111School of Health, Wellington Faculty of Health, Victoria University of Wellington, Wellington, New Zealand ,grid.4305.20000 0004 1936 7988Usher Institute, University of Edinburgh, Edinburgh, UK
| | - T. Shi
- grid.4305.20000 0004 1936 7988Usher Institute, University of Edinburgh, Edinburgh, UK
| | - E. Vasileiou
- grid.4305.20000 0004 1936 7988Usher Institute, University of Edinburgh, Edinburgh, UK
| | - S. V. Katikireddi
- grid.8756.c0000 0001 2193 314XMRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - S. Kerr
- grid.4305.20000 0004 1936 7988Usher Institute, University of Edinburgh, Edinburgh, UK
| | - E. Moore
- grid.508718.3Public Health Scotland, Glasgow, Scotland
| | - C. McCowan
- grid.11914.3c0000 0001 0721 1626School of Medicine, University of St. Andrews, St. Andrews, UK
| | - U. Agrawal
- grid.11914.3c0000 0001 0721 1626School of Medicine, University of St. Andrews, St. Andrews, UK
| | - S. A. Shah
- grid.4305.20000 0004 1936 7988Usher Institute, University of Edinburgh, Edinburgh, UK
| | - L. D. Ritchie
- grid.7107.10000 0004 1936 7291Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK
| | - J. Murray
- grid.508718.3Public Health Scotland, Glasgow, Scotland
| | - J. Pan
- grid.11984.350000000121138138Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - D. T. Bradley
- grid.4777.30000 0004 0374 7521Queen’s University Belfast, Belfast, UK ,grid.454053.30000 0004 0494 5490Public Health Agency, Belfast, Northern Ireland
| | - S. J. Stock
- grid.4305.20000 0004 1936 7988Usher Institute, University of Edinburgh, Edinburgh, UK
| | - R. Wood
- grid.4305.20000 0004 1936 7988Usher Institute, University of Edinburgh, Edinburgh, UK ,grid.508718.3Public Health Scotland, Glasgow, Scotland
| | - A. Chuter
- grid.507332.0Health Data Research UK, BREATHE Hub, Edinburgh, UK
| | - J. Beggs
- grid.507332.0Health Data Research UK, BREATHE Hub, Edinburgh, UK
| | - H. R. Stagg
- grid.4305.20000 0004 1936 7988Usher Institute, University of Edinburgh, Edinburgh, UK
| | - M. Joy
- grid.4991.50000 0004 1936 8948Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - R. S. M. Tsang
- grid.4991.50000 0004 1936 8948Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - S. de Lusignan
- grid.4991.50000 0004 1936 8948Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - R. Hobbs
- grid.4991.50000 0004 1936 8948Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - R. A. Lyons
- grid.4827.90000 0001 0658 8800Population Data Science, Swansea University, Swansea, UK
| | - F. Torabi
- grid.4827.90000 0001 0658 8800Population Data Science, Swansea University, Swansea, UK
| | - S. Bedston
- grid.4827.90000 0001 0658 8800Population Data Science, Swansea University, Swansea, UK
| | - M. O’Leary
- grid.508718.3Public Health Scotland, Glasgow, Scotland
| | - A. Akbari
- grid.4827.90000 0001 0658 8800Population Data Science, Swansea University, Swansea, UK
| | - J. McMenamin
- grid.508718.3Public Health Scotland, Glasgow, Scotland
| | - C. Robertson
- grid.508718.3Public Health Scotland, Glasgow, Scotland ,grid.11984.350000000121138138Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - A. Sheikh
- grid.4305.20000 0004 1936 7988Usher Institute, University of Edinburgh, Edinburgh, UK ,grid.507332.0Health Data Research UK, BREATHE Hub, Edinburgh, UK
| |
Collapse
|
48
|
Williams GJ, Chen H, Kim J, Kerr S, Khater HY. Comment on "Table-Top Laser-Based Source of Femtosecond, Collimated, Ultrarelativistic Positron Beams". Phys Rev Lett 2020; 124:179501. [PMID: 32412254 DOI: 10.1103/physrevlett.124.179501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 10/23/2019] [Accepted: 04/08/2020] [Indexed: 06/11/2023]
Affiliation(s)
- G J Williams
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - Hui Chen
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - J Kim
- Center for Energy Research, University of California, San Diego, California 92093, USA
| | - S Kerr
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - H Y Khater
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| |
Collapse
|
49
|
Williams GJ, Link A, Sherlock M, Alessi DA, Bowers M, Conder A, Di Nicola P, Fiksel G, Fiuza F, Hamamoto M, Hermann MR, Herriot S, Homoelle D, Hsing W, d'Humières E, Kalantar D, Kemp A, Kerr S, Kim J, LaFortune KN, Lawson J, Lowe-Webb R, Ma T, Mariscal DA, Martinez D, Manuel MJE, Nakai M, Pelz L, Prantil M, Remington B, Sigurdsson R, Widmayer C, Williams W, Willingale L, Zacharias R, Youngblood K, Chen H. Production of relativistic electrons at subrelativistic laser intensities. Phys Rev E 2020; 101:031201. [PMID: 32289929 DOI: 10.1103/physreve.101.031201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 02/06/2020] [Indexed: 06/11/2023]
Abstract
Relativistic electron temperatures were measured from kilojoule, subrelativistic laser-plasma interactions. Experiments show an order of magnitude higher temperatures than expected from a ponderomotive scaling, where temperatures of up to 2.2 MeV were generated using an intensity of 1×10^{18}W/cm^{2}. Two-dimensional particle-in-cell simulations suggest that electrons gain superponderomotive energies by stochastic acceleration as they sample a large area of rapidly changing laser phase. We demonstrate that such high temperatures are possible from subrelativistic intensities by using lasers with long pulse durations and large spatial scales.
Collapse
Affiliation(s)
- G J Williams
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - A Link
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - M Sherlock
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - D A Alessi
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - M Bowers
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - A Conder
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - P Di Nicola
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - G Fiksel
- Center for Ultrafast Optical Science, University of Michigan, Ann Arbor, Michigan 48109, USA
| | - F Fiuza
- High Energy Density Science Division, SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
| | - M Hamamoto
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - M R Hermann
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - S Herriot
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - D Homoelle
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - W Hsing
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | | | - D Kalantar
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - A Kemp
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - S Kerr
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - J Kim
- Center for Energy Research, University of California, San Diego, California 92093, USA
| | - K N LaFortune
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - J Lawson
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - R Lowe-Webb
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - T Ma
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - D A Mariscal
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - D Martinez
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - M J-E Manuel
- General Atomics, San Diego, California 92186, USA
| | - M Nakai
- Institute of Laser Engineering, Osaka University, 2-6 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - L Pelz
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - M Prantil
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - B Remington
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - R Sigurdsson
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - C Widmayer
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - W Williams
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - L Willingale
- Center for Ultrafast Optical Science, University of Michigan, Ann Arbor, Michigan 48109, USA
| | - R Zacharias
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - K Youngblood
- General Atomics, San Diego, California 92186, USA
| | - Hui Chen
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| |
Collapse
|
50
|
Bagaria M, Kerr S, Heinzen E, Maurer M, Shields E, Lemens M, Shridhar V, Bakkum-Gamez J. Determining the methylation patterns of clinically normal endometrium and multiple tumor regions from uteri containing endometrial cancer. Gynecol Oncol 2019. [DOI: 10.1016/j.ygyno.2019.03.222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|